Provider Demographics
NPI:1619940756
Name:KINGSLEY, DANIEL G (PT, OCS, COMT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:G
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:PT, OCS, COMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 ROUTE 5 W
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037
Mailing Address - Country:US
Mailing Address - Phone:315-510-3372
Mailing Address - Fax:315-510-3688
Practice Address - Street 1:1398 ROUTE 5 W
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037
Practice Address - Country:US
Practice Address - Phone:315-510-3372
Practice Address - Fax:315-510-3688
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020163225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
11324752OtherCAQH
NYP00959640OtherRAILROAD MEDICARE
NYJ400004198Medicare UPIN