Provider Demographics
NPI:1518275163
Name:LIEUWEN, DANIEL M
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:LIEUWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 1/2 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-1944
Mailing Address - Country:US
Mailing Address - Phone:920-562-6366
Mailing Address - Fax:
Practice Address - Street 1:217 1/2 PLEASANT PL
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1944
Practice Address - Country:US
Practice Address - Phone:920-562-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant