Basic Information
| Provider Information | |||||||||
| NPI: | 1588852123 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KARDULAS | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 138 MOSES GERRISH FARMER RD | ||||||||
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| City: | ELIOT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039031840 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 112 SANFORD RD | ||||||||
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| City: | WELLS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040905533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076460373 | ||||||||
| FaxNumber: | 2076460381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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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 | 225200000X | PA3094 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.