Provider Demographics
NPI:1851302004
Name:LOMBARD, DANEL (MPT)
Entity type:Individual
Prefix:MS
First Name:DANEL
Middle Name:
Last Name:LOMBARD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 DE LA VINA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 N NASH ST STE 306
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2850
Practice Address - Country:US
Practice Address - Phone:310-535-0008
Practice Address - Fax:310-535-0009
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40667225100000X
PAPT016045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB216263Medicare PIN
PA2236557000OtherKEYSTONE IND BLUE CROSS
306182OtherUNISON
PA30070995OtherKEYSTONE MERCY
PA1851302004OtherBRAVO
PA080330VLZMedicare PIN
DE1851302004OtherDPCI
PA102404765-0001Medicaid