MEDICARE: MR. DANJUN PAET

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	225200000X	Physical Therapy Assistant	2306602507	VA

General Provider Information

NPI Number	:	1518233261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANJUN PAET

Provider Business Mailing Address
First Line	:	4828 GATWICK DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4828 GATWICK DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6437
Country	:	US
Telephone Number	:	757-434-9440
Fax Number	:

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

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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