Provider Demographics
NPI:1982085171
Name:FORADORI, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FORADORI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2062 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-7696
Mailing Address - Country:US
Mailing Address - Phone:850-855-8188
Mailing Address - Fax:
Practice Address - Street 1:4686 E ASBURY CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4723
Practice Address - Country:US
Practice Address - Phone:303-756-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0013566225200000X
FLPTA24923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant