Provider Demographics
NPI:1538299565
Name:SLOTTERBACK, DANIEL DAVID (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
Last Name:SLOTTERBACK
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 FAIRGROUNDS ROAD
Mailing Address - Street 2:
Mailing Address - City:LAVELLE
Mailing Address - State:PA
Mailing Address - Zip Code:17943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2655 WOODGLEN RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1335
Practice Address - Country:US
Practice Address - Phone:570-622-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0031612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer