Provider Demographics
NPI:1215453162
Name:FROST, DANIEL (LAT, ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FROST
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TUNNEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:FACTORYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18419-2309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11749 STATE ROUTE 106
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:PA
Practice Address - Zip Code:18826-6942
Practice Address - Country:US
Practice Address - Phone:570-434-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0055892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer