MEDICARE: DR. DANIEL A LIGHT PT, DPT

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	PT37573	FL

General Provider Information

NPI Number	:	1326714734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL A LIGHT PT, DPT

Provider Business Mailing Address
First Line	:	1518 WHITEHALL DR APT 304
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-6637
Country	:	US
Telephone Number	:	954-661-3729
Fax Number	:

Provider Business Practice Location Address
First Line	:	6290 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1917
Country	:	US
Telephone Number	:	954-302-8746
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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