Provider Demographics
NPI:1376942946
Name:FLETCHER, DANIEL (ATC LAT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:ATC LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 SE RIDGEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66609-1541
Mailing Address - Country:US
Mailing Address - Phone:785-969-4749
Mailing Address - Fax:
Practice Address - Street 1:4136 SE RIDGEVIEW TER
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66609-1541
Practice Address - Country:US
Practice Address - Phone:785-969-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5290582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer