Provider Demographics
NPI:1194809970
Name:DANIELS, DANA A (PT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:A
Other - Last Name:LEATHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 MIDWESTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2211
Mailing Address - Country:US
Mailing Address - Phone:940-322-0771
Mailing Address - Fax:940-767-4943
Practice Address - Street 1:2611 PLAZA PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3886
Practice Address - Country:US
Practice Address - Phone:940-691-1114
Practice Address - Fax:940-691-1125
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048698OtherBCBS BLUE LINK NUMBER
TX8T0338OtherBLUE CROSS BLUE SHIELD ID