Provider Demographics
NPI:1588077465
Name:KOEHL, DANIEL VINCENT (ATC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:VINCENT
Last Name:KOEHL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-6213
Mailing Address - Country:US
Mailing Address - Phone:571-839-0274
Mailing Address - Fax:
Practice Address - Street 1:5 BRYANT ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6213
Practice Address - Country:US
Practice Address - Phone:571-839-0274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer