Provider Demographics
NPI:1114625621
Name:MAUL, DANIEL T (LPTA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:T
Last Name:MAUL
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-1534
Mailing Address - Country:US
Mailing Address - Phone:636-293-8141
Mailing Address - Fax:
Practice Address - Street 1:9645 BIG BEND BLVD # RR
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6521
Practice Address - Country:US
Practice Address - Phone:314-968-5460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019006240225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant