Provider Demographics
NPI:1245565845
Name:KERTIS, DANIEL ALAN (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:KERTIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-9503
Mailing Address - Country:US
Mailing Address - Phone:251-221-3000
Mailing Address - Fax:251-221-3004
Practice Address - Street 1:8901 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9503
Practice Address - Country:US
Practice Address - Phone:251-221-3000
Practice Address - Fax:251-221-3004
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer