Provider Demographics
NPI:1568721256
Name:COLORADO, DANIELLE ANTOINETTE (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANTOINETTE
Last Name:COLORADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 4TH AVENUE SUITE 509
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-951-6790
Mailing Address - Fax:
Practice Address - Street 1:480 4TH AVE STE 509
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4414
Practice Address - Country:US
Practice Address - Phone:619-951-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant