=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770648412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIELS THERAPY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 SOUTH DR SUITE211
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-934-0455
-----------------------------------------------------
Fax | 650-934-0456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 525 SOUTH DR SUITE211
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-4213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-934-0455
-----------------------------------------------------
Fax | 650-934-0456
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RONALD KOLBY DANIELS
-----------------------------------------------------
Credential | MHS, PT
-----------------------------------------------------
Telephone | 650-934-0455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | PT14315
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------