Basic Information
| Provider Information | |||||||||
| NPI: | 1356311567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | SIBI | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 584 N STATE RD | ||||||||
| Address2: | |||||||||
| City: | BRIARCLIFF MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105101522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147622222 | ||||||||
| FaxNumber: | 9147629175 | ||||||||
| Practice Location | |||||||||
| Address1: | 584 N STATE RD | ||||||||
| Address2: | |||||||||
| City: | BRIARCLIFF MANOR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105101522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147622222 | ||||||||
| FaxNumber: | 9147629175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 0265781 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1191533 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 854T79 | 01 | TX | BCBS ORTHOTEXAS | OTHER |