Healthcare Provider Details

I. General information

NPI: 1902299852
Provider Name (Legal Business Name): DANIEL LEIB DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 HAMPTON DR # 2
VENICE CA
90291-3018
US

IV. Provider business mailing address

8828 PERSHING DR APT 131
PLAYA DEL REY CA
90293-8005
US

V. Phone/Fax

Practice location:
  • Phone: 360-710-7144
  • Fax:
Mailing address:
  • Phone: 360-710-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: