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General NPI Number Information
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NPI Number | 1992244388
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Entity Type | Individual
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Provider Name | DARRYL BLAKE WITHROW PT
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Gender | Male
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 931 YORK DR SUITE A
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City | DESOTO
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State | TX
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Zip | 75115-2043
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Country | US
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Telephone | 972-296-6645
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Fax | 972-296-4526
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1287741
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License Number State | TX
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