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General NPI Number Information
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NPI Number | 1497354096
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Entity Type | Individual
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Provider Name | DANIEL GLEN SPEED JR. PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 5577 MONROE ST STE A1
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City | SYLVANIA
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State | OH
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Zip | 43560-2565
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Country | US
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Telephone | 419-318-8104
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Fax | 419-540-9067
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 630-575-1914
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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 | PT021426
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License Number State | AL
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