Provider Demographics
NPI:1487426276
Name:MEDINA, DANIEL ELIAS (DPT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELIAS
Last Name:MEDINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3101 VALENTINO CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10461 WHITE GRANITE DR STE 106
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2762
Practice Address - Country:US
Practice Address - Phone:703-559-6823
Practice Address - Fax:888-546-3565
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist