Provider Demographics
NPI:1588982318
Name:GROSS, DANIEL (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 WALRAVEN DR
Mailing Address - Street 2:APT 2B
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5122
Mailing Address - Country:US
Mailing Address - Phone:201-233-2626
Mailing Address - Fax:
Practice Address - Street 1:72 WALRAVEN DR
Practice Address - Street 2:APT 2B
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5122
Practice Address - Country:US
Practice Address - Phone:201-233-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist