Provider Demographics
NPI:1396901823
Name:LAMPREY, DARYL T (PT)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:T
Last Name:LAMPREY
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 1:411 PRAIRIE HEIGHTS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2238
Mailing Address - Country:US
Mailing Address - Phone:608-848-6628
Mailing Address - Fax:608-848-6629
Practice Address - Street 1:411 PRAIRIE HEIGHTS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-2238
Practice Address - Country:US
Practice Address - Phone:608-848-6628
Practice Address - Fax:608-848-6629
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11884-24225100000X
MA18332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist