Provider Demographics
NPI:1710266101
Name:RUBIO, DANIELL ANANDA (LMT)
Entity Type:Individual
Prefix:MR
First Name:DANIELL
Middle Name:ANANDA
Last Name:RUBIO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2379
Mailing Address - Country:US
Mailing Address - Phone:541-510-5734
Mailing Address - Fax:
Practice Address - Street 1:2775 FRIENDLY ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2254
Practice Address - Country:US
Practice Address - Phone:541-510-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6594172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist