Provider Demographics
NPI:1558754614
Name:MUNKLEY, DANIEL III (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MUNKLEY
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CREDIT UNION WAY
Mailing Address - Street 2:FL. 3
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4633
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-961-1291
Practice Address - Street 1:1350 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3447
Practice Address - Country:US
Practice Address - Phone:617-267-3773
Practice Address - Fax:617-602-1010
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110110059AMedicaid
MAS400252881OtherMEDICARE PTAN