Healthcare Provider Details

I. General information

NPI: 1720414717
Provider Name (Legal Business Name): DANIEL JAMES O'LEARY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GILBERT AVE
SMITHTOWN NY
11787-5326
US

IV. Provider business mailing address

998 CARMANS RD
MASSAPEQUA NY
11758-3505
US

V. Phone/Fax

Practice location:
  • Phone: 631-724-1991
  • Fax: 631-724-0984
Mailing address:
  • Phone: 516-541-4730
  • Fax: 516-541-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number036518-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: