Healthcare Provider Details

I. General information

NPI: 1407419005
Provider Name (Legal Business Name): DANIEL JONATHAN WU P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

IV. Provider business mailing address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 714-256-5074
  • Fax: 714-256-0770
Mailing address:
  • Phone: 714-256-5074
  • Fax: 714-256-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number41683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: