Provider Demographics
NPI:1043673767
Name:MYERS, DANIEL (LAT, ATC,FMSC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:LAT, ATC,FMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SUSSEX DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1506
Mailing Address - Country:US
Mailing Address - Phone:302-841-1580
Mailing Address - Fax:
Practice Address - Street 1:45 SUSSEX DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1506
Practice Address - Country:US
Practice Address - Phone:302-841-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TN31162255A2300X
PART0071402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer