Provider Demographics
NPI:1760690788
Name:WORLEY, DANIEL JOHN ROBERTSON
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN ROBERTSON
Last Name:WORLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 GARFIELD ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3052
Mailing Address - Country:US
Mailing Address - Phone:612-788-0246
Mailing Address - Fax:
Practice Address - Street 1:2842 GARFIELD ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3052
Practice Address - Country:US
Practice Address - Phone:612-788-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62632251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics