Healthcare Provider Details

I. General information

NPI: 1275200453
Provider Name (Legal Business Name): DANIELLE RACE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE TOMES

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4585 N FIGUEROA ST
LOS ANGELES CA
90065-3026
US

IV. Provider business mailing address

1145 W SIERRA MADRE AVE APT 4
AZUSA CA
91702-1645
US

V. Phone/Fax

Practice location:
  • Phone: 323-223-3441
  • Fax:
Mailing address:
  • Phone: 909-581-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT296990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: