Provider Demographics
NPI:1780288696
Name:DANIELIAN, EKATERINA
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:DANIELIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 SWINGLINE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-3135
Mailing Address - Country:US
Mailing Address - Phone:818-400-0940
Mailing Address - Fax:
Practice Address - Street 1:75 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4381
Practice Address - Country:US
Practice Address - Phone:470-740-7419
Practice Address - Fax:770-882-2837
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant