Provider Demographics
NPI:1720062581
Name:MANGAN, DANIEL JAMES (MPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:MANGAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41653 MARGARITA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-2906
Mailing Address - Country:US
Mailing Address - Phone:951-296-0400
Mailing Address - Fax:951-296-5162
Practice Address - Street 1:41653 MARGARITA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-2906
Practice Address - Country:US
Practice Address - Phone:951-296-0400
Practice Address - Fax:951-296-5162
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT243510OtherBLUE SHIELD
WA0208672OtherWA DEPT OF LABOR
WA0208672OtherWA DEPT OF LABOR
CAOPT243510Medicare UPIN