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NPI Code Detail

MEDICARE: MR. DANIEL MADISON LENT KOOP MPT, CHT

MEDICARE: MR. DANIEL MADISON LENT KOOP MPT, CHT
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
12251H1200XHand Physical Therapist1061100674CA
2225100000XPhysical Therapist4129NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2650001175OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14129OTHERNMPT LICENSE

General Provider Information

NPI Number : 1982618898
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL MADISON LENT KOOP MPT, CHT
Provider Business Mailing Address
First Line : 5817 RIO ANIMAS RD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-4719
Country : US
Telephone Number : 505-206-4625
Fax Number :
Provider Business Practice Location Address
First Line : 3001 BROADMOOR BLVD NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-2100
Country : US
Telephone Number : 505-994-7131
Fax Number : 505-994-7155
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 01/28/2013

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