MEDICARE: MICHAEL DALEY

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

General Provider Information

NPI Number	:	1821292780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL DALEY

Provider Business Mailing Address
First Line	:	360 N MAIN ST
Second Line	:	SUITE 9
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2503
Country	:	US
Telephone Number	:	860-621-7389
Fax Number	:	860-621-2586

Provider Business Practice Location Address
First Line	:	98 MAIN ST
Second Line	:	SUITE 202
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-620-9453
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL DALEY
Credential	:	P.T.
Telephone Number	:	860-621-7389

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2020

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