Provider Demographics
NPI:1104841048
Name:CIANCI, DAMON (PT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:CIANCI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2010
Mailing Address - Country:US
Mailing Address - Phone:510-526-2353
Mailing Address - Fax:510-526-2022
Practice Address - Street 1:948 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2010
Practice Address - Country:US
Practice Address - Phone:510-526-2353
Practice Address - Fax:510-526-2022
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT322190Medicare ID - Type Unspecified