Provider Demographics
NPI:1942031380
Name:PATINO, DANIEL (DPT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:PATINO
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 1:2542 WILDCAT CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9460
Mailing Address - Country:US
Mailing Address - Phone:254-652-1682
Mailing Address - Fax:
Practice Address - Street 1:1188 N SALEM RD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8803
Practice Address - Country:US
Practice Address - Phone:479-595-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist