Provider Demographics
NPI:1700094299
Name:MACCA, DANIEL (MSPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MACCA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28430 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MELFA
Mailing Address - State:VA
Mailing Address - Zip Code:23410-2903
Mailing Address - Country:US
Mailing Address - Phone:757-442-5222
Mailing Address - Fax:757-442-6333
Practice Address - Street 1:36082 LANKFORD HWY
Practice Address - Street 2:
Practice Address - City:BELLE HAVEN
Practice Address - State:VA
Practice Address - Zip Code:23306
Practice Address - Country:US
Practice Address - Phone:757-442-5222
Practice Address - Fax:757-442-6333
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist