Provider Demographics
NPI:1952136202
Name:CARLSON, DANIELLE (PTA)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 58TH ST SW UNIT A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5915
Mailing Address - Country:US
Mailing Address - Phone:360-510-5108
Mailing Address - Fax:
Practice Address - Street 1:2000 W MARINE VIEW DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-5000
Practice Address - Country:US
Practice Address - Phone:425-304-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160655942225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant