MEDICARE: MR. DANIEL L PAGAN P.T.

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	PT-09320	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341972661	OTHER	OH	TAX ID
2	PT-09320	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1588667059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL L PAGAN P.T.

Provider Business Mailing Address
First Line	:	3736 BOARDMAN CANFIELD RD
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-8039
Country	:	US
Telephone Number	:	330-533-8350
Fax Number	:	330-533-8338

Provider Business Practice Location Address
First Line	:	3736 BOARDMAN CANFIELD RD
Second Line	:
City	:	CANFIELD
State	:	OH
Zip	:	44406-8039
Country	:	US
Telephone Number	:	330-533-8350
Fax Number	:	330-533-8338

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/22/2009

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