Provider Demographics
NPI:1881814887
Name:PAIC, DAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:PAIC
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 1:14424 CARDIFF LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64840-9107
Mailing Address - Country:US
Mailing Address - Phone:417-325-4377
Mailing Address - Fax:
Practice Address - Street 1:2727 MC CLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1626
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist