Provider Demographics
NPI:1114359908
Name:PARK, DANIEL Y (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:Y
Last Name:PARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1769
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118-1769
Mailing Address - Country:US
Mailing Address - Phone:540-687-8181
Mailing Address - Fax:540-687-8256
Practice Address - Street 1:8550 LEE HWY
Practice Address - Street 2:SUITE 450
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1515
Practice Address - Country:US
Practice Address - Phone:703-208-1002
Practice Address - Fax:703-208-1127
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist