Provider Demographics
NPI:1992283766
Name:MALDONADO, JUAN DANIEL JR (DPT)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:DANIEL
Last Name:MALDONADO
Suffix:JR
Gender:M
Credentials:DPT
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Mailing Address - Street 1:4430 MISSOURI AVENUE
Mailing Address - Street 2:BOX #1267
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473
Mailing Address - Country:US
Mailing Address - Phone:573-596-1707
Mailing Address - Fax:321-802-5811
Practice Address - Street 1:4430 MISSOURI AVENUE
Practice Address - Street 2:BOX #1267
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-596-0417
Practice Address - Fax:321-802-5811
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-06-20
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Provider Licenses
StateLicense IDTaxonomies
FLPT33776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist