Provider Demographics
NPI:1063587541
Name:PETERS, DANIEL R (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:PETERS
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 1:3160 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1185
Mailing Address - Country:US
Mailing Address - Phone:334-699-2348
Mailing Address - Fax:334-699-2347
Practice Address - Street 1:3160 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1185
Practice Address - Country:US
Practice Address - Phone:334-699-2348
Practice Address - Fax:334-699-2347
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist