Provider Demographics
NPI:1659816775
Name:CASEY, DANIEL ADAM (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ADAM
Last Name:CASEY
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 1:120 E CREEK DR APT 12A
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3650
Mailing Address - Country:US
Mailing Address - Phone:650-834-1809
Mailing Address - Fax:
Practice Address - Street 1:120 E CREEK DR APT 12A
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3650
Practice Address - Country:US
Practice Address - Phone:650-834-1809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist