Provider Demographics
NPI:1174367809
Name:CLEVELAND, DANIELLE NIKOLE (ATC)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NIKOLE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7379 BROOKMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8913
Mailing Address - Country:US
Mailing Address - Phone:571-442-4873
Mailing Address - Fax:
Practice Address - Street 1:1000 LONGFELLOW BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6034
Practice Address - Country:US
Practice Address - Phone:571-442-4873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260041162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer