Provider Demographics
NPI:1922044296
Name:DALY, JEFF (MSPT)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:DALY
Suffix:
Gender:M
Credentials:MSPT
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 1:213 GREENHILL AVE
Practice Address - Street 2:STE C
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1844
Practice Address - Country:US
Practice Address - Phone:302-658-7800
Practice Address - Fax:302-658-1550
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ100001352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037583Medicaid
1828900OtherPABS
P00400294OtherRR MEDICARE
2683069000OtherAMERIHEALTH/IBC
5070-0014OtherCAREFIRST/FEDERAL
620719-01OtherCAREFIRST/NCA
DE007527F68Medicare ID - Type Unspecified
2683069000OtherAMERIHEALTH/IBC
P33553Medicare UPIN