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General NPI Number Information
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NPI Number | 1215025754
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Entity Type | Individual
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Provider Name | STEPHEN ERNEST DAISEY MPT
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 7007 LANKFORD HWY
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City | OAK HALL
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State | VA
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Zip | 23416-2223
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Country | US
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Telephone | 757-854-0500
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Fax | 757-854-0545
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | ATLANTIC
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State | VA
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Zip | 23303-0396
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Country | US
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Telephone | 757-854-0500
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Fax | 757-854-0545
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2305204289
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License Number State | VA
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