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NPI Code Detail

MEDICARE: MR. DANIEL WILLIAM CICCHELLI P.T.

MEDICARE: MR. DANIEL WILLIAM CICCHELLI P.T.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT23883CA

General Provider Information

NPI Number : 1710017405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL WILLIAM CICCHELLI P.T.
Provider Business Mailing Address
First Line : 6991 BALBOA AVE
Second Line : ROOM 70
City : SAN DIEGO
State : CA
Zip : 92111-3447
Country : US
Telephone Number : 858-496-8232
Fax Number : 858-496-8234
Provider Business Practice Location Address
First Line : 6991 BALBOA AVE
Second Line : ROOM 70
City : SAN DIEGO
State : CA
Zip : 92111-3447
Country : US
Telephone Number : 858-496-8232
Fax Number : 858-496-8234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 07/08/2007

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