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General NPI Number Information
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NPI Number | 1326714734
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Entity Type | Individual
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Provider Name | DANIEL A LIGHT PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 6290 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-1917
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Country | US
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Telephone | 954-302-8746
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 WHITEHALL DR APT 304
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City | DAVIE
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State | FL
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Zip | 33324-6637
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Country | US
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Telephone | 954-661-3729
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT37573
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License Number State | FL
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