Basic Information
| Provider Information | |||||||||
| NPI: | 1700817624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COMER | ||||||||
| FirstName: | DANIEL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23825 COMMERCE PARK DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162926363 | ||||||||
| FaxNumber: | 2162926306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 TRANSPORTATION DR | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403292890 | ||||||||
| FaxNumber: | 4403292899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 08/19/2009 | ||||||||
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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 | 225100000X | PT-8280 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 2742518 | 05 | OH | MEDICAID | P00383584 | 01 | OH | MEDICARE RAILROAD | OTHER |