Provider Demographics
NPI:1881636678
Name:BAUGHAN, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BAUGHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEY CENTER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2950
Practice Address - Country:US
Practice Address - Phone:302-994-1200
Practice Address - Fax:302-994-1233
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100001507225100000X
PAPT011115L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5070-0009OtherCARE FIRST
619247601OtherNCA
DE1000037723Medicaid
745825OtherPABS
246555OtherMAMSI
0840574000OtherAMERIHEALTH IBC
11795675OtherCAQH
840574000OtherAMERIHEALTH
619247601OtherNCA
131422VKFMedicare PIN
745825OtherPABS
DE006540F68Medicare ID - Type Unspecified
$$$$$$$$$OtherCHAMPUS
840574000OtherAMERIHEALTH