Provider Demographics
NPI:1255410254
Name:KING, DANIEL JOSEPH (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:KING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 LAWN DR
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-2227
Mailing Address - Country:US
Mailing Address - Phone:312-835-7900
Mailing Address - Fax:708-482-9788
Practice Address - Street 1:5804 LAWN DR
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-2227
Practice Address - Country:US
Practice Address - Phone:312-835-7900
Practice Address - Fax:708-482-9789
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70004650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211081Medicare ID - Type UnspecifiedDAN KING THERAPY SERVICES