Provider Demographics
NPI:1043688534
Name:SOBOL, DANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SOBOL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8653
Mailing Address - Country:US
Mailing Address - Phone:928-775-9999
Mailing Address - Fax:928-775-9998
Practice Address - Street 1:8400 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8653
Practice Address - Country:US
Practice Address - Phone:928-775-9999
Practice Address - Fax:928-775-9998
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11760A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant