Provider Demographics
NPI:1255304242
Name:FALCHETTI, DANIEL (PT, MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FALCHETTI
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2492 WALNUT AVENUE, #140
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6953
Mailing Address - Country:US
Mailing Address - Phone:714-544-2188
Mailing Address - Fax:714-544-2189
Practice Address - Street 1:2492 WALNUT AVENUE, #140
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6953
Practice Address - Country:US
Practice Address - Phone:714-544-2188
Practice Address - Fax:714-544-2189
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT24798AMedicare PIN