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NPI Code Detail

MEDICARE: DANIEL WESLEY TEEKEL PTA

MEDICARE: DANIEL WESLEY TEEKEL PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2131428TX

General Provider Information

NPI Number : 1396219846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL WESLEY TEEKEL PTA
Provider Business Mailing Address
First Line : 5500 OVERTON RIDGE BLVD STE 228
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-3281
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5500 OVERTON RIDGE BLVD STE 228
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-3281
Country : US
Telephone Number : 817-259-1255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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Directions to “ DANIEL WESLEY TEEKEL PTA” Practice Location

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