Provider Demographics
NPI:1881694834
Name:BURNS, DANIEL CARL (MSPT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:CARL
Last Name:BURNS
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:PO BOX 1833
Mailing Address - Street 2:885 POINT BROWN AVE NW
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-1833
Mailing Address - Country:US
Mailing Address - Phone:360-289-0251
Mailing Address - Fax:360-289-3226
Practice Address - Street 1:885 POINT BROWN AVE NW
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9682
Practice Address - Country:US
Practice Address - Phone:360-289-0251
Practice Address - Fax:360-289-3226
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8368078Medicaid
WAG8857812Medicare PIN
WAGAB39358Medicare PIN
WA8368078Medicaid