Provider Demographics
NPI:1285784884
Name:KATZ, DANIEL EDWARD (PT, LAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:KATZ
Suffix:
Gender:M
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7412
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04112-7412
Mailing Address - Country:US
Mailing Address - Phone:207-347-7132
Mailing Address - Fax:207-347-3527
Practice Address - Street 1:83 INDIA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4210
Practice Address - Country:US
Practice Address - Phone:207-347-7132
Practice Address - Fax:207-347-3527
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC281171100000X
MEPT3116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171100000XOther Service ProvidersAcupuncturist