Provider Demographics
NPI:1184774085
Name:TADEO, DANIELLE (PT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TADEO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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 1:115 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6333
Practice Address - Country:US
Practice Address - Phone:610-565-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013448L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1952584Medicaid
PA049681NU9Medicare ID - Type Unspecified