Provider Demographics
NPI:1336360858
Name:WEISBERG, DANIEL ALAN (PT ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:WEISBERG
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 SHERMAN WAY
Mailing Address - Street 2:UNIT 16
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3536
Mailing Address - Country:US
Mailing Address - Phone:818-262-6888
Mailing Address - Fax:
Practice Address - Street 1:19231 SHERMAN WAY
Practice Address - Street 2:UNIT 16
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3536
Practice Address - Country:US
Practice Address - Phone:818-262-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT 27041225100000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer