Provider Demographics
NPI:1790456754
Name:CECIL, DANIEL (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CECIL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 5TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1290
Mailing Address - Country:US
Mailing Address - Phone:304-525-4445
Mailing Address - Fax:304-529-7442
Practice Address - Street 1:2240 5TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1290
Practice Address - Country:US
Practice Address - Phone:304-525-4445
Practice Address - Fax:304-529-7442
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2784225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant