Provider Demographics
NPI:1356948350
Name:DANIEL, THECLA (CMT)
Entity type:Individual
Prefix:
First Name:THECLA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-4742
Mailing Address - Country:US
Mailing Address - Phone:510-629-0098
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3099
Practice Address - Country:US
Practice Address - Phone:510-629-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-03
Last Update Date:2023-10-13
Deactivation Date:2022-02-15
Deactivation Code:
Reactivation Date:2023-10-13
Provider Licenses
StateLicense IDTaxonomies
CA13921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist