Provider Demographics
NPI:1902946197
Name:HARPER, DANIEL WAYNE (PTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WAYNE
Last Name:HARPER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1426
Mailing Address - Country:US
Mailing Address - Phone:772-778-3295
Mailing Address - Fax:
Practice Address - Street 1:100 S US 1
Practice Address - Street 2:SUITE 6
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-1426
Practice Address - Country:US
Practice Address - Phone:772-562-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19693225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant