=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275125924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL TASHMAN DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2021
-----------------------------------------------------
Last Update Date | 02/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 ROLLING OAKS DR STE 100
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91361-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-499-4446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6750 GLADE AVE APT 113
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-2565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-730-4830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT299732
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------