Provider Demographics
NPI:1013993211
Name:DANIEL, SANDRA LYNN (PT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LYNN
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:BORDEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7290 NAVAJO RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1629
Mailing Address - Country:US
Mailing Address - Phone:619-535-6964
Mailing Address - Fax:619-724-6427
Practice Address - Street 1:7290 NAVAJO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1629
Practice Address - Country:US
Practice Address - Phone:619-535-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25518AMedicare PIN