Provider Demographics
NPI:1225139777
Name:SOUZA, DANIEL A (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:SOUZA
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 1:653 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2808
Mailing Address - Country:US
Mailing Address - Phone:949-496-0122
Mailing Address - Fax:949-496-5027
Practice Address - Street 1:653 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2808
Practice Address - Country:US
Practice Address - Phone:949-496-0122
Practice Address - Fax:949-496-5027
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT12321AMedicare ID - Type UnspecifiedINDIVIDUAL ID NUMBER