Provider Demographics
NPI:1265754451
Name:BANNINK, DANIEL ERIC (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ERIC
Last Name:BANNINK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2362
Mailing Address - Country:US
Mailing Address - Phone:248-393-7707
Mailing Address - Fax:248-393-7708
Practice Address - Street 1:3009 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2362
Practice Address - Country:US
Practice Address - Phone:248-393-7707
Practice Address - Fax:248-393-7708
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist