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General NPI Number Information
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NPI Number | 1912142373
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Entity Type | Individual
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Provider Name | DANIEL RICHARD FRIDOLFSSON DPT
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Gender | Male
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 3700 QUALITY DR.
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City | VACAVILLE
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State | CA
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Zip | 95688
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Country | US
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Telephone | 707-453-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 4501 ALHAMBRA DR APT #240
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City | DAVIS
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State | CA
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Zip | 95618-7146
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Country | US
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Telephone | 707-980-0946
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 35041
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License Number State | CA
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