Healthcare Provider Details

I. General information

NPI: 1588185946
Provider Name (Legal Business Name): DANIEL WESLEY WILLEY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 GORDON NAGLE TRL STE 100
POTTSVILLE PA
17901-4203
US

IV. Provider business mailing address

430 INNOVATION DR
BLAIRSVILLE PA
15717-8096
US

V. Phone/Fax

Practice location:
  • Phone: 570-399-5331
  • Fax: 570-399-5374
Mailing address:
  • Phone: 724-343-4060
  • Fax: 724-343-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT026091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: