Individual
DANIELLE ILEANA CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
23770 HOSPITAL ST, CASSOPOLIS, MI 49031-9644
(269) 445-3801
Mailing address
3704 SAINT ANDREWS PL, ELKHART, IN 46517-3848
(904) 607-9518
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005675A
IN
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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