Provider Demographics
NPI:1245753482
Name:KHAN, DANIAL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KINGS HWY N STE 108
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 KINGS HWY N STE 108
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1906
Practice Address - Country:US
Practice Address - Phone:856-330-4360
Practice Address - Fax:856-330-4281
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2023-12-07
Deactivation Date:2017-12-05
Deactivation Code:
Reactivation Date:2019-11-18
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01728300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist