MEDICARE: DANIEL MCILROY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184234296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL MCILROY PT, DPT

Provider Business Mailing Address
First Line	:	3363 CYPRESS LEGENDS CIR APT 1234
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33905-5547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18900 N TAMIAMI TRL STE 5
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-7307
Country	:	US
Telephone Number	:	239-731-6222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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