Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1306741 | TX |
NPI | 1104306216 |
---|---|
Provider Name | Danielle Staley |
First Address | Conroe, TX 77303-1578 |
Second Address | Abilene, TX 79605-4603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 15/07/2020 |