Provider Demographics
NPI:1538716303
Name:GIERSE, DANIEL (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GIERSE
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 SHOREHAM DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1240
Mailing Address - Country:US
Mailing Address - Phone:314-717-2928
Mailing Address - Fax:
Practice Address - Street 1:2112 SHOREHAM DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1240
Practice Address - Country:US
Practice Address - Phone:314-717-2928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190331202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer