Provider Demographics
NPI:1447707609
Name:KVENVIK, DANIEL ADAM (PTA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ADAM
Last Name:KVENVIK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 STATE ROUTE 27
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3979
Mailing Address - Country:US
Mailing Address - Phone:732-545-7474
Mailing Address - Fax:732-545-2880
Practice Address - Street 1:1527 STATE ROUTE 27
Practice Address - Street 2:SUITE 1100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3979
Practice Address - Country:US
Practice Address - Phone:732-545-7474
Practice Address - Fax:732-545-2880
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00322800225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant