Provider Demographics
NPI:1457510190
Name:WOECKEL, DANNY AUGUST (PT)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:AUGUST
Last Name:WOECKEL
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 1:1901 BRANDYWYN LN
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6693
Mailing Address - Country:US
Mailing Address - Phone:843-685-0615
Mailing Address - Fax:
Practice Address - Street 1:1901 BRANDYWYN LN
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6693
Practice Address - Country:US
Practice Address - Phone:843-685-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5657225100000X
NC11489225100000X
IL070-003772225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist