Provider Demographics
NPI:1164106472
Name:DEUEL, DANIEL HARRISON
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HARRISON
Last Name:DEUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 OLD STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-3024
Mailing Address - Country:US
Mailing Address - Phone:510-301-9683
Mailing Address - Fax:
Practice Address - Street 1:3825 OLD STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3024
Practice Address - Country:US
Practice Address - Phone:318-599-9508
Practice Address - Fax:318-810-2007
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist