Provider Demographics
NPI:1144391343
Name:KEVORKIAN, DANIEL DOUGLAS (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:KEVORKIAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LENTZ DR
Mailing Address - Street 2:# 90 B
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5135
Mailing Address - Country:US
Mailing Address - Phone:615-283-7346
Mailing Address - Fax:
Practice Address - Street 1:500 LENTZ DR
Practice Address - Street 2:# 90 B
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5135
Practice Address - Country:US
Practice Address - Phone:615-283-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist