Provider Demographics
NPI:1831600733
Name:WILCOX, DANIEL EDWARD (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:WILCOX
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 1:650 WHITNEY RANCH DR APT 3011
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2619
Mailing Address - Country:US
Mailing Address - Phone:951-258-4685
Mailing Address - Fax:
Practice Address - Street 1:2411 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5780
Practice Address - Country:US
Practice Address - Phone:702-458-1300
Practice Address - Fax:702-750-1372
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist