Provider Demographics
NPI:1619690955
Name:DANIELS, KEITH EVERETTE III (DPT)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:EVERETTE
Last Name:DANIELS
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 1:20 SCATTERGOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1431
Mailing Address - Country:US
Mailing Address - Phone:856-298-2532
Mailing Address - Fax:
Practice Address - Street 1:496 KINGS HWY N STE 110
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1015
Practice Address - Country:US
Practice Address - Phone:856-438-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02118000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty