Provider Demographics
NPI:1881847036
Name:KONCELIK, DANIEL MICHAEL (LMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MICHAEL
Last Name:KONCELIK
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 1:7 HARRIS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2888
Mailing Address - Country:US
Mailing Address - Phone:617-971-9500
Mailing Address - Fax:
Practice Address - Street 1:7 HARRIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2888
Practice Address - Country:US
Practice Address - Phone:617-971-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3713172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist