Provider Demographics
NPI:1255401311
Name:MASSEY, DARYL K (PT, MPT)
Entity type:Individual
Prefix:MRS
First Name:DARYL
Middle Name:K
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3673
Mailing Address - Country:US
Mailing Address - Phone:847-923-0046
Mailing Address - Fax:847-923-0047
Practice Address - Street 1:1544 NERGE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3673
Practice Address - Country:US
Practice Address - Phone:847-923-0046
Practice Address - Fax:847-923-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635922OtherBLUE CROSS BLUE SHIELD
IL214753Medicare PIN
IL01635922OtherBLUE CROSS BLUE SHIELD