Provider Demographics
NPI:1447318381
Name:BAJADA, DANIEL JOHN ILANO (MPT)
Entity type:Individual
Prefix:
First Name:DANIEL JOHN
Middle Name:ILANO
Last Name:BAJADA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:JOHN
Other - Last Name:BAJADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2255 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3343
Mailing Address - Country:US
Mailing Address - Phone:925-930-6680
Mailing Address - Fax:925-930-7867
Practice Address - Street 1:2255 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3343
Practice Address - Country:US
Practice Address - Phone:925-930-6680
Practice Address - Fax:925-930-7867
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist