Provider Demographics
NPI:1588709810
Name:PARADIS, DANIEL K (PT & OWNER)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:K
Last Name:PARADIS
Suffix:
Gender:M
Credentials:PT & OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3831
Mailing Address - Country:US
Mailing Address - Phone:970-765-0818
Mailing Address - Fax:970-497-8410
Practice Address - Street 1:257 COTTONWOOD STREET
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416
Practice Address - Country:US
Practice Address - Phone:970-874-6111
Practice Address - Fax:970-874-6116
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01078309OtherRAILROAD WORKERS MEDICARE
COCOA108701OtherPTAN
C20813Medicare UPIN