Provider Demographics
NPI:1801942230
Name:BACKMAN, DANIEL R (PT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:R
Last Name:BACKMAN
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 1:36424 ASH ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54747-8727
Mailing Address - Country:US
Mailing Address - Phone:715-985-2998
Mailing Address - Fax:
Practice Address - Street 1:18601 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8605
Practice Address - Country:US
Practice Address - Phone:715-538-4361
Practice Address - Fax:715-538-1700
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5292-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist