Provider Demographics
NPI:1356880637
Name:KELLEHER, DANIEL JOHN (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOHN
Last Name:KELLEHER
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 1:242 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1180
Mailing Address - Country:US
Mailing Address - Phone:607-857-9230
Mailing Address - Fax:
Practice Address - Street 1:242 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1180
Practice Address - Country:US
Practice Address - Phone:607-857-9230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist