Provider Demographics
NPI:1083943955
Name:PANIZA, DORIE
Entity Type:Individual
Prefix:MRS
First Name:DORIE
Middle Name:
Last Name:PANIZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171A SCHOOL ST.
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014
Mailing Address - Country:US
Mailing Address - Phone:650-756-3740
Mailing Address - Fax:650-756-3890
Practice Address - Street 1:171A SCHOOL ST.
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014
Practice Address - Country:US
Practice Address - Phone:650-756-3740
Practice Address - Fax:650-756-3890
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist