Provider Demographics
NPI:1699821777
Name:PROCTOR, DANIEL J (LPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4114
Mailing Address - Country:US
Mailing Address - Phone:940-566-5714
Mailing Address - Fax:940-381-0157
Practice Address - Street 1:534 N ELM ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4114
Practice Address - Country:US
Practice Address - Phone:940-566-5714
Practice Address - Fax:940-381-0157
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist