Provider Demographics
NPI:1700802741
Name:MIDDLETON, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MIDDLETON
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 1:535 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-5254
Mailing Address - Country:US
Mailing Address - Phone:781-961-3370
Mailing Address - Fax:781-767-7531
Practice Address - Street 1:63 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4820
Practice Address - Country:US
Practice Address - Phone:781-961-9200
Practice Address - Fax:781-961-6599
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0363278Medicaid
MA0363278Medicaid