Provider Demographics
NPI:1336963503
Name:BANUELOS, DANIEL JR (DPT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BANUELOS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 PRADO DR
Mailing Address - Street 2:
Mailing Address - City:SOLEDAD
Mailing Address - State:CA
Mailing Address - Zip Code:93960-3329
Mailing Address - Country:US
Mailing Address - Phone:831-737-8214
Mailing Address - Fax:
Practice Address - Street 1:1916 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-2034
Practice Address - Country:US
Practice Address - Phone:831-276-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist