Provider Demographics
NPI:1407354343
Name:BEICKE, DANIEL P (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:BEICKE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 S IRWINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2821
Mailing Address - Country:US
Mailing Address - Phone:716-462-1939
Mailing Address - Fax:
Practice Address - Street 1:31 S IRWINWOOD RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2821
Practice Address - Country:US
Practice Address - Phone:716-462-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011147-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant