Provider Demographics
NPI:1750847752
Name:THE TRAVELING PHYSICAL THERAPIST
Entity Type:Organization
Organization Name:THE TRAVELING PHYSICAL THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT CSCS
Authorized Official - Phone:646-733-4737
Mailing Address - Street 1:150 VETS HWY UNIT 141
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-6408
Mailing Address - Country:US
Mailing Address - Phone:917-207-3541
Mailing Address - Fax:
Practice Address - Street 1:117 STONEHURST LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7930
Practice Address - Country:US
Practice Address - Phone:646-733-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty