Provider Demographics
NPI:1578934204
Name:STAGG, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STAGG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3974
Mailing Address - Country:US
Mailing Address - Phone:801-602-5384
Mailing Address - Fax:
Practice Address - Street 1:992 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3974
Practice Address - Country:US
Practice Address - Phone:801-602-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT339794-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist