Provider Demographics
NPI:1568822823
Name:MAGANA, DANIEL AVILA (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:AVILA
Last Name:MAGANA
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 1:702 THORNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-1147
Mailing Address - Country:US
Mailing Address - Phone:831-262-8728
Mailing Address - Fax:
Practice Address - Street 1:702 THORNDALE AVE
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1147
Practice Address - Country:US
Practice Address - Phone:831-262-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9513225100000X
CA41195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist