Provider Demographics
NPI:1215025754
Name:DAISEY, STEPHEN ERNEST (MPT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ERNEST
Last Name:DAISEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:VA
Mailing Address - Zip Code:23303-0396
Mailing Address - Country:US
Mailing Address - Phone:757-854-0500
Mailing Address - Fax:757-854-0545
Practice Address - Street 1:7007 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:OAK HALL
Practice Address - State:VA
Practice Address - Zip Code:23416-2223
Practice Address - Country:US
Practice Address - Phone:757-854-0500
Practice Address - Fax:757-854-0545
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052042892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA203535898OtherCIGNA
VA10008313OtherSENTARA/OPTIMA
VA203535898OtherTRICARE
VA195578OtherANTHEM BCBS
VA203535898OtherAETNA
VA5102853OtherMAMSI, UNITED HEALTHCARE
VA203535898OtherCIGNA
VA00W799D01Medicare ID - Type Unspecified