MEDICARE: DANIEL JOSEPH KING P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	70004650	IL

General Provider Information

NPI Number	:	1255410254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOSEPH KING P.T.

Provider Business Mailing Address
First Line	:	5804 LAWN DR
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2227
Country	:	US
Telephone Number	:	312-835-7900
Fax Number	:	708-482-9788

Provider Business Practice Location Address
First Line	:	5804 LAWN DR
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2227
Country	:	US
Telephone Number	:	312-835-7900
Fax Number	:	708-482-9789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	01/18/2022

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