Healthcare Provider Details

I. General information

NPI: 1003265398
Provider Name (Legal Business Name): DORIAN DANIC D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST STE 102
LOS ANGELES CA
90033-1061
US

IV. Provider business mailing address

1218 PINE ST. APT. 204
SOUTH PASADENA CA
91030
US

V. Phone/Fax

Practice location:
  • Phone: 323-224-7070
  • Fax:
Mailing address:
  • Phone: 626-617-7877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: