Basic Information
| Provider Information | |||||||||
| NPI: | 1063932952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIMMERICK | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 SADDLEBROOK CURV | ||||||||
| Address2: | |||||||||
| City: | CHANHASSEN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553179025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017205437 | ||||||||
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| Practice Location | |||||||||
| Address1: | 775 PRAIRIE CENTER DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553447334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529445314 | ||||||||
| FaxNumber: | 9529440092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2017 | ||||||||
| LastUpdateDate: | 06/22/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251S0007X | 10730 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | 10730 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 10730 | MN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.