MEDICARE: MS. DANA DIANNE TOLBERT P.T

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
1	225100000X	Physical Therapist	1057735	TX

General Provider Information

NPI Number	:	1851321194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA DIANNE TOLBERT P.T

Provider Business Mailing Address
First Line	:	601 S BUCHTA RD
Second Line	:
City	:	ANGLETON
State	:	TX
Zip	:	77515-4178
Country	:	US
Telephone Number	:	979-848-1292
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 CIRCLE WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5233
Country	:	US
Telephone Number	:	979-480-9400
Fax Number	:	979-480-9410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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