Healthcare Provider Details

I. General information

NPI: 1275613945
Provider Name (Legal Business Name): DANIEL SAGE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 JOG RD SUITE B3
DELRAY BEACH FL
33446-3806
US

IV. Provider business mailing address

PO BOX 8396
DELRAY BEACH FL
33482-8396
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-5144
  • Fax: 561-496-5201
Mailing address:
  • Phone: 561-496-5144
  • Fax: 561-496-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 14578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: