Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1750644217 |
---|---|
Provider Name | Mr. Dequinton J Daniel |
First Address | Dallas, TX 75233-3112 |
Second Address | Dallas, TX 75216-7167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2012 |
Last Update Date | 20/06/2012 |