Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1318785 | TX |
NPI | 1518513449 |
---|---|
Provider Name | Danielle Farzanegan |
First Address | Houston, TX 77063-1164 |
Second Address | Houston, TX 77094-1285 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2019 |
Last Update Date | 15/08/2019 |