Provider Demographics
NPI:1477721009
Name:ROSENBAUM, DANIEL (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ROSENBAUM
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 1:3596 PEBBLE PATH LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1614
Mailing Address - Country:US
Mailing Address - Phone:732-859-4879
Mailing Address - Fax:
Practice Address - Street 1:251 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-8303
Practice Address - Country:US
Practice Address - Phone:321-725-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist