Provider Demographics
NPI:1790974673
Name:PAULEY, DANIEL A (PT, OCS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:PAULEY
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 N PORT WASHINGTON RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-5470
Mailing Address - Country:US
Mailing Address - Phone:414-332-0707
Mailing Address - Fax:414-332-3670
Practice Address - Street 1:5150 N PORT WASHINGTON RD STE 130
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5470
Practice Address - Country:US
Practice Address - Phone:414-332-0707
Practice Address - Fax:414-332-3670
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391605943011OtherBCBS GROUP
WI40169700Medicaid