Basic Information
| Provider Information | |||||||||
| NPI: | 1679106975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1681 DAYTON AVE APT 4 | ||||||||
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| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551046189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179468684 | ||||||||
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| Practice Location | |||||||||
| Address1: | 730 CLEVELAND AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517568525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2020 | ||||||||
| LastUpdateDate: | 02/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 20200000109 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.