Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10730 | MN |
N | 2251S0007X | Physical Therapist - Sports | 10730 | MN |
N | 2251X0800X | Physical Therapist - Orthopedic | 10730 | MN |
NPI | 1063932952 |
---|---|
Provider Name | Daniel Himmerick |
First Address | Chanhassen, MN 55317-9025 |
Second Address | Eden Prairie, MN 55344-7334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 22/06/2017 |