Provider Demographics
NPI:1689086480
Name:KRIKIE, DANIELLE KATHLEEN (PTA)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHLEEN
Last Name:KRIKIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:KATHLEEN
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:SHAWNEETOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62984-0773
Mailing Address - Country:US
Mailing Address - Phone:618-382-2771
Mailing Address - Fax:618-382-2772
Practice Address - Street 1:108 APRIL AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1577
Practice Address - Country:US
Practice Address - Phone:618-382-2771
Practice Address - Fax:618-382-2272
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160006713225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant