Provider Demographics
NPI:1306868039
Name:STAATS, DANIEL (PT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:STAATS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6055
Mailing Address - Country:US
Mailing Address - Phone:732-920-0880
Mailing Address - Fax:
Practice Address - Street 1:489 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6055
Practice Address - Country:US
Practice Address - Phone:732-920-0880
Practice Address - Fax:732-920-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01133700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ127248YWGMedicare PIN