Provider Demographics
NPI:1447325592
Name:MYERS, DANIEL S (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:S
Last Name:MYERS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 KIEL AVE
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1706
Mailing Address - Country:US
Mailing Address - Phone:973-838-3733
Mailing Address - Fax:973-492-5822
Practice Address - Street 1:17 KIEL AVE
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-1706
Practice Address - Country:US
Practice Address - Phone:973-838-3733
Practice Address - Fax:973-492-5822
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO3671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025567Medicare ID - Type Unspecified