Provider Demographics
NPI:1356521785
Name:PETERY, DANIEL E
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:PETERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-5231
Mailing Address - Country:US
Mailing Address - Phone:216-685-1595
Mailing Address - Fax:216-685-1605
Practice Address - Street 1:1420 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-5231
Practice Address - Country:US
Practice Address - Phone:216-685-1595
Practice Address - Fax:216-685-1605
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications