Healthcare Provider Details

I. General information

NPI: 1316442494
Provider Name (Legal Business Name): DANIELLE KHOURY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 CHANCERY LN
CAVE SPRINGS AR
72718
US

IV. Provider business mailing address

1013 CHANCERY LN
CAVE SPRINGS AR
72718-9104
US

V. Phone/Fax

Practice location:
  • Phone: 214-232-4169
  • Fax:
Mailing address:
  • Phone: 214-232-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number10677591-2401
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT4761
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: