Provider Demographics
NPI:1497564512
Name:DEAL, DARRYL
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:DEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 RED COACH DR STE 106
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3195
Mailing Address - Country:US
Mailing Address - Phone:574-318-7800
Mailing Address - Fax:574-318-7839
Practice Address - Street 1:229 RED COACH DR STE 106
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3195
Practice Address - Country:US
Practice Address - Phone:574-318-7800
Practice Address - Fax:574-318-7839
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist