Provider Demographics
NPI:1790758951
Name:DANIEL, ANDRE (ATC, CSCS, NASM-PES)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:DANIEL
Suffix:
Gender:M
Credentials:ATC, CSCS, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 S CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4249
Mailing Address - Country:US
Mailing Address - Phone:414-559-6680
Mailing Address - Fax:
Practice Address - Street 1:3501 S LAKE DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53235-0900
Practice Address - Country:US
Practice Address - Phone:414-294-4900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer