Provider Demographics
NPI:1154639706
Name:FLACK, DANIEL PAUL (PTA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:FLACK
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 1:849 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3838
Mailing Address - Country:US
Mailing Address - Phone:717-267-1521
Mailing Address - Fax:
Practice Address - Street 1:849 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3838
Practice Address - Country:US
Practice Address - Phone:717-267-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002064225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant