Provider Demographics
NPI:1093198145
Name:HEREL, PHILLIP DANIEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DANIEL
Last Name:HEREL
Suffix:
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 1:50760 NECTAREO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8542
Mailing Address - Country:US
Mailing Address - Phone:310-625-0505
Mailing Address - Fax:
Practice Address - Street 1:73010 EL PASEO STE B
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4248
Practice Address - Country:US
Practice Address - Phone:442-234-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist