Provider Demographics
NPI:1093327298
Name:CABRAL, DANIEL (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CABRAL
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HYACINTH DR APT 1K
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2409
Mailing Address - Country:US
Mailing Address - Phone:732-877-2670
Mailing Address - Fax:
Practice Address - Street 1:1 PATRIOTS PARK
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3454
Practice Address - Country:US
Practice Address - Phone:908-203-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002730002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer