Provider Demographics
NPI:1730711680
Name:PATTON, DANIELLE REBECCA
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:REBECCA
Last Name:PATTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13303 HAWKS VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8726
Mailing Address - Country:US
Mailing Address - Phone:260-318-4337
Mailing Address - Fax:
Practice Address - Street 1:13303 HAWKS VIEW BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-8726
Practice Address - Country:US
Practice Address - Phone:260-318-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer