Provider Demographics
NPI:1578978375
Name:MACHADO, DANIEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MACHADO
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 1:3500 BARRETT DR APT 9F
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1029
Mailing Address - Country:US
Mailing Address - Phone:973-986-6240
Mailing Address - Fax:
Practice Address - Street 1:3500 BARRETT DR APT 9F
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1029
Practice Address - Country:US
Practice Address - Phone:973-986-6240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00249100225200000X
NJ4OQA1561500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant