1164488375 NPI number — MRS. DANIELLE T CANNELLA MPT

Table of content: MRS. DANIELLE T CANNELLA MPT (NPI 1164488375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164488375 NPI number — MRS. DANIELLE T CANNELLA MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANNELLA
Provider First Name:
DANIELLE
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TROMBETTA SEIDER
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164488375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 ENTERPRISE PKWY
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-6249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-827-2481
Provider Business Mailing Address Fax Number:
757-827-2566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 ENTERPRISE PKWY
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-6249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-827-2481
Provider Business Practice Location Address Fax Number:
757-827-2566
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305202228 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010189179 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7839617 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00201729 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 192931 . This is a "BCBS PHYSICAL THERAPY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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