Healthcare Provider Details

I. General information

NPI: 1225389851
Provider Name (Legal Business Name): DANIEL LEE PREISSNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N325 MILITARY RD
SHERWOOD WI
54169-9661
US

IV. Provider business mailing address

N325 MILITARY RD
SHERWOOD WI
54169-9661
US

V. Phone/Fax

Practice location:
  • Phone: 920-843-2477
  • Fax:
Mailing address:
  • Phone: 920-843-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1882-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: