Provider Demographics
NPI:1821205105
Name:COX, DANIEL LEE (LMT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:COX
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 9TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5222
Mailing Address - Country:US
Mailing Address - Phone:503-819-7658
Mailing Address - Fax:
Practice Address - Street 1:1489 9TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-5222
Practice Address - Country:US
Practice Address - Phone:503-819-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023340174400000X
OR11952174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00023340OtherMASSAGE PRACTITIONER
OR11952OtherLICENSED MASSAGE THERAPIS