Provider Demographics
NPI:1114686474
Name:BAGLEY, DANIEL FRANKLIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FRANKLIN
Last Name:BAGLEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:274 BLUE POND RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7492
Mailing Address - Country:US
Mailing Address - Phone:919-793-6764
Mailing Address - Fax:
Practice Address - Street 1:166 SPRINGBROOK AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8520
Practice Address - Country:US
Practice Address - Phone:919-793-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant