Provider Demographics
NPI:1275007478
Name:VALLEJO, DANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:VALLEJO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 AVENUE OF THE AMERICAS # AT49TH
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1001
Mailing Address - Country:US
Mailing Address - Phone:646-562-0617
Mailing Address - Fax:914-315-1799
Practice Address - Street 1:1221 AVENUE OF THE AMERICAS # AT49TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1001
Practice Address - Country:US
Practice Address - Phone:646-562-0617
Practice Address - Fax:914-315-1799
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist