Provider Demographics
NPI:1619524394
Name:GROSS, DANIEL (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GROSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BRICK BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6031
Mailing Address - Country:US
Mailing Address - Phone:732-255-9500
Mailing Address - Fax:
Practice Address - Street 1:317 BRICK BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6031
Practice Address - Country:US
Practice Address - Phone:732-255-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301256225100000X
MA26501225100000X
NJ40QA01872700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist