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General NPI Number Information
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NPI Number | 1235600198
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Entity Type | Individual
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Provider Name | JACOB MICHAEL DANIEL
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 2110 16TH ST STE 7
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City | BAY CITY
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State | MI
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Zip | 48708-7609
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Country | US
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Telephone | 800-840-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 8171 N RIVER RD
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City | FREELAND
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State | MI
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Zip | 48623-9566
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Country | US
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Telephone | 989-293-8839
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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