MEDICARE: MR. DANIEL JAMES GAGE PHYSICAL THERAPIST

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	11425-24	WI
2	2251X0800X	Orthopedic Physical Therapist	PT00005165	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639176431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL JAMES GAGE PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	1300 S GREEN BAY RD STE 205
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4469
Country	:	US
Telephone Number	:	262-898-3930
Fax Number	:	262-898-3933

Provider Business Practice Location Address
First Line	:	1300 S GREEN BAY RD STE 205
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4469
Country	:	US
Telephone Number	:	262-898-3930
Fax Number	:	262-898-3933

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2021

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