=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043422173
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID TODD DENHAM P. T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12429 SCOFIELD FARMS DR
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78758-2640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-339-8687
-----------------------------------------------------
Fax | 512-339-8687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1702 S MAIN ST
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78626-7924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-863-9229
-----------------------------------------------------
Fax | 512-339-8687
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1088714
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------