Provider Demographics
NPI:1255989208
Name:DAO, THOMAS N (DPT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:N
Last Name:DAO
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 1:20040 BALTAR ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1994
Mailing Address - Country:US
Mailing Address - Phone:818-403-8944
Mailing Address - Fax:
Practice Address - Street 1:18855 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6445
Practice Address - Country:US
Practice Address - Phone:818-774-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA294649OtherPHYSICAL THERAPIST LICENSE