Provider Demographics
NPI:1144413667
Name:CHITWOOD, DANIEL MARTIN (PT, DPT, LMT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MARTIN
Last Name:CHITWOOD
Suffix:
Gender:M
Credentials:PT, DPT, LMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 E SPRING MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-9207
Mailing Address - Country:US
Mailing Address - Phone:520-907-6116
Mailing Address - Fax:
Practice Address - Street 1:1200 W ROUTE 66
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6238
Practice Address - Country:US
Practice Address - Phone:928-556-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7779225100000X
AZMT-05208225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist