Provider Demographics
NPI:1295849636
Name:SHEETS, DANIEL P (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:SHEETS
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 1:15333 SE OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-7860
Mailing Address - Country:US
Mailing Address - Phone:503-819-7526
Mailing Address - Fax:503-296-2347
Practice Address - Street 1:15333 SE OGDEN DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-7860
Practice Address - Country:US
Practice Address - Phone:503-819-7526
Practice Address - Fax:503-296-2347
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2817225100000X
WAPT00006487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295849636Medicare NSC