Provider Demographics
NPI:1063746493
Name:MARTIN, DANIEL (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 PONTEVERDE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6528
Mailing Address - Country:US
Mailing Address - Phone:530-758-1508
Mailing Address - Fax:530-758-1508
Practice Address - Street 1:3002 PONTEVERDE LN
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6528
Practice Address - Country:US
Practice Address - Phone:530-758-1508
Practice Address - Fax:530-758-1508
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist