Provider Demographics
NPI:1417503293
Name:BEVER, DANIEL KANOA (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KANOA
Last Name:BEVER
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 1:1520 NUTMEG PL STE 111
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2557
Mailing Address - Country:US
Mailing Address - Phone:714-979-3500
Mailing Address - Fax:714-939-9880
Practice Address - Street 1:1520 NUTMEG PL STE 111
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2557
Practice Address - Country:US
Practice Address - Phone:714-979-3500
Practice Address - Fax:714-979-9880
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist