Provider Demographics
NPI:1487136818
Name:DANIELL, MELISSA (PTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DANIELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 JUNIPER COVE RD
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692
Mailing Address - Country:US
Mailing Address - Phone:254-221-2646
Mailing Address - Fax:
Practice Address - Street 1:1000 FM 3220
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634
Practice Address - Country:US
Practice Address - Phone:254-675-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2116853OtherPTA