Provider Demographics
NPI:1285785451
Name:DANIEL, DEE-DEE (DPT)
Entity type:Individual
Prefix:
First Name:DEE-DEE
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6719
Mailing Address - Country:US
Mailing Address - Phone:304-255-9248
Mailing Address - Fax:304-255-9237
Practice Address - Street 1:2233 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6719
Practice Address - Country:US
Practice Address - Phone:304-255-9248
Practice Address - Fax:304-255-9237
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9420001Medicaid
WV1302443OtherUMWA
WV1056886Medicare UPIN