Provider Demographics
NPI:1821051202
Name:MURDOCK, DARYL (PT)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21773
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-0966
Mailing Address - Country:US
Mailing Address - Phone:619-715-5811
Mailing Address - Fax:619-334-7338
Practice Address - Street 1:2163 SHIRE DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2657
Practice Address - Country:US
Practice Address - Phone:619-715-5811
Practice Address - Fax:619-334-7338
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist