Healthcare Provider Details

I. General information

NPI: 1609867068
Provider Name (Legal Business Name): DANIEL KINNEY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31225 LA BAYA DR SUITE 206
WESTLAKE VILLAGE CA
91362-4019
US

IV. Provider business mailing address

31225 LA BAYA DR SUITE 206
WESTLAKE VILLAGE CA
91362-4019
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-3131
  • Fax: 805-494-3002
Mailing address:
  • Phone: 805-494-3131
  • Fax: 805-494-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: