Provider Demographics
NPI:1528356391
Name:STREETER, DANIEL TIMOTHY (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:TIMOTHY
Last Name:STREETER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VREELAND RD.
Mailing Address - Street 2:BUILDING A SUITE #110
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-660-1000
Mailing Address - Fax:973-660-1008
Practice Address - Street 1:30 VREELAND RD.
Practice Address - Street 2:BUILDING A SUITE #110
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-660-1000
Practice Address - Fax:973-660-1008
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI40QA01403400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist