Provider Demographics
NPI:1083108633
Name:DANIELS, KATHERINE LEE HREZO
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEE HREZO
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LEE
Other - Last Name:HREZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3236 TINKER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9554
Mailing Address - Country:US
Mailing Address - Phone:530-966-2541
Mailing Address - Fax:
Practice Address - Street 1:3236 TINKER CREEK WAY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9554
Practice Address - Country:US
Practice Address - Phone:530-966-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist