Provider Demographics
NPI:1942387295
Name:MCCULLOUGH, DANNY LEONARD (MPT)
Entity Type:Individual
Prefix:MR
First Name:DANNY
Middle Name:LEONARD
Last Name:MCCULLOUGH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SE MONTEREY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-288-2400
Mailing Address - Fax:
Practice Address - Street 1:124 SW CHAMBER CT
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3496
Practice Address - Country:US
Practice Address - Phone:772-288-2400
Practice Address - Fax:772-419-0144
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21723225100000X
PAPT019752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist