Provider Demographics
NPI:1487075412
Name:MONROE, DANIEL (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MONROE
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 1:8455 FLYING CLOUD DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3974
Mailing Address - Country:US
Mailing Address - Phone:952-993-7470
Mailing Address - Fax:
Practice Address - Street 1:8455 FLYING CLOUD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3974
Practice Address - Country:US
Practice Address - Phone:952-993-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist