MEDICARE: TRACY ANN DANIELAK MSPT

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

General Provider Information

NPI Number	:	1356558084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY ANN DANIELAK MSPT

Provider Business Mailing Address
First Line	:	104 CEDAR RUN RD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-3504
Country	:	US
Telephone Number	:	732-606-0526
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 ATLANTIC CITY BLVD
Second Line	:	340 ROUTE 9 PENN FEDERAL PLAZA
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-1255
Country	:	US
Telephone Number	:	973-361-5500
Fax Number	:	973-361-5080

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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