Provider Demographics
NPI:1750387809
Name:LIST, DANIEL WALLACE (MSPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:WALLACE
Last Name:LIST
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Gender:M
Credentials:MSPT
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Mailing Address - Street 1:9017 FOREST HILL AVE SUITE 2B
Mailing Address - Street 2:JAMES RIVER PHYSICAL THERAPY
Mailing Address - City:N. CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-330-0936
Mailing Address - Fax:804-330-0937
Practice Address - Street 1:9017 FOREST HILL AVE SUITE 2B
Practice Address - Street 2:JAMES RIVER PHYSICAL THERAPY
Practice Address - City:N. CHESTFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-330-0936
Practice Address - Fax:804-330-0937
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
VA2305202065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006106R47Medicare PIN