Healthcare Provider Details

I. General information

NPI: 1528038544
Provider Name (Legal Business Name): MICHAEL DAACK MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 CEDAR RAVINE RD
PLACERVILLE CA
95667-5617
US

IV. Provider business mailing address

1007 GENEVA CT
EL DORADO HILLS CA
95762-4003
US

V. Phone/Fax

Practice location:
  • Phone: 530-621-2773
  • Fax:
Mailing address:
  • Phone: 916-941-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT24113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: