Provider Demographics
NPI:1114050275
Name:DALEY, TIMOTHY E (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:E
Last Name:DALEY
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 1:1178 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-6006
Mailing Address - Country:US
Mailing Address - Phone:714-289-7790
Mailing Address - Fax:714-289-7786
Practice Address - Street 1:1178 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6006
Practice Address - Country:US
Practice Address - Phone:714-289-7790
Practice Address - Fax:714-289-7786
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1154327922OtherTYPE TWO NPI NUMBER
CA1154327922OtherTYPE TWO NPI NUMBER