Provider Demographics
NPI:1982890257
Name:DARNER, WAYNE R (PT)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:R
Last Name:DARNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3912
Mailing Address - Country:US
Mailing Address - Phone:817-731-9331
Mailing Address - Fax:817-731-9882
Practice Address - Street 1:6080 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3912
Practice Address - Country:US
Practice Address - Phone:817-731-9331
Practice Address - Fax:817-731-9882
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00434EOtherMEDICARE GROUP
TX1176703OtherPT LICENSE
P00689444OtherMEDICARE RAILROAD CARRIER
TX8T7546OtherBCBS
P00689444Medicare PIN
TX8K2000Medicare PIN