Healthcare Provider Details

I. General information

NPI: 1598910226
Provider Name (Legal Business Name): DANIEL E FLYNN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 WATERFORD LAKES PKWY STE 115
ORLANDO FL
32828-4500
US

IV. Provider business mailing address

12780 WATERFORD LAKES PKWY STE 115
ORLANDO FL
32828-4500
US

V. Phone/Fax

Practice location:
  • Phone: 407-207-7188
  • Fax: 407-207-7103
Mailing address:
  • Phone: 407-207-7188
  • Fax: 407-207-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: