Basic Information
| Provider Information | |||||||||
| NPI: | 1750767679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | CALEB | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 BRIAR RIDGE CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720765367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019825632 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 HENDERSON ST | ||||||||
| Address2: | HSU BOX 7894 | ||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702305426 | ||||||||
| FaxNumber: | 8702305175 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2015 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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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 | 2255A2300X | AT 683 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.