Provider Demographics
NPI:1689301509
Name:TODD, DANYELLE ELLSWORTH
Entity type:Individual
Prefix:
First Name:DANYELLE
Middle Name:ELLSWORTH
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANYELLE
Other - Middle Name:BREANN
Other - Last Name:ELLSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1013 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5340
Practice Address - Country:US
Practice Address - Phone:512-876-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist