Provider Demographics
NPI:1336853092
Name:VINING, DANIEL RICHARD (LMT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICHARD
Last Name:VINING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6514
Mailing Address - Country:US
Mailing Address - Phone:203-240-9102
Mailing Address - Fax:
Practice Address - Street 1:30 SPRING ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6514
Practice Address - Country:US
Practice Address - Phone:203-240-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03317225700000X
CT11104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist