Provider Demographics
NPI:1184103475
Name:DALY, JOHN GARRAHAN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GARRAHAN
Last Name:DALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 CONSTITUTION AVE NE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5931
Mailing Address - Country:US
Mailing Address - Phone:505-255-5099
Mailing Address - Fax:505-255-2406
Practice Address - Street 1:6020 CONSTITUTION AVE NE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5931
Practice Address - Country:US
Practice Address - Phone:505-255-5099
Practice Address - Fax:505-255-2406
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist