Provider Demographics
NPI:1730569971
Name:LAPOLLA, DANIEL JOSEPH (PTA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:LAPOLLA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 GRANADA BLVD
Mailing Address - Street 2:SUITE 4B2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-615-1112
Mailing Address - Fax:386-615-1164
Practice Address - Street 1:1275 GRANADA BLVD
Practice Address - Street 2:SUITE 4B2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-615-1112
Practice Address - Fax:386-615-1164
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPTA25717225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant