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General NPI Number Information
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NPI Number | 1568855245
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Entity Type | Individual
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Provider Name | DANIELLE KEYES M.ED, ATC,LAT
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Gender | Female
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 14350 FM 1488 RD
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City | MAGNOLIA
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State | TX
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Zip | 77354-1665
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Country | US
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Telephone | 281-252-2158
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Fax |
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Provider Business Mailing Address
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Address Line | 11743 NORTHPOINTE BLVD UNIT 1027
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City | TOMBALL
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State | TX
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Zip | 77377-5574
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Country | US
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Telephone | 904-338-8515
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT5941
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License Number State | TX
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