Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1291038 | TX |
NPI | 1073100616 |
---|---|
Provider Name | Daniel Coleman |
First Address | Sachse, TX 75048-4729 |
Second Address | Sachse, TX 75048-4729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2020 |
Last Update Date | 29/12/2020 |