Provider Demographics
NPI:1588037675
Name:RICHARDS, DANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADOW LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2460
Mailing Address - Country:US
Mailing Address - Phone:814-375-6830
Mailing Address - Fax:
Practice Address - Street 1:100 MEADOW LN
Practice Address - Street 2:SUITE 2
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2460
Practice Address - Country:US
Practice Address - Phone:814-375-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009982208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation