MEDICARE: DTP TRANSPORT LLC

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	172A00000X	Driver

General Provider Information

NPI Number	:	1285301101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DTP TRANSPORT LLC

Provider Business Mailing Address
First Line	:	7003 VILLA DEL SOL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2333
Country	:	US
Telephone Number	:	281-960-1391
Fax Number	:	281-506-7973

Provider Business Practice Location Address
First Line	:	7003 VILLA DEL SOL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2333
Country	:	US
Telephone Number	:	281-960-1391
Fax Number	:	281-506-7973

Authorized Official
Title or Position	:	CEO
Name	:	LATARSHA MCCRIMMON
Credential	:
Telephone Number	:	281-960-1391

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	08/27/2021

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