Provider Demographics
NPI:1073939880
Name:DANIELS, NAOMI (PTA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26027 106TH PL SE
Mailing Address - Street 2:#C-301
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6731
Mailing Address - Country:US
Mailing Address - Phone:253-856-0085
Mailing Address - Fax:
Practice Address - Street 1:26027 106TH PL SE
Practice Address - Street 2:#C-301
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6731
Practice Address - Country:US
Practice Address - Phone:253-856-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60033434225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant