MEDICARE: DANIELLE DEIDRE JAMES PT

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	225100000X	Physical Therapist	1165780	TX

General Provider Information

NPI Number	:	1558654111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE DEIDRE JAMES PT

Provider Business Mailing Address
First Line	:	3805 W ALABAMA ST APT 3108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5249
Country	:	US
Telephone Number	:	832-605-3264
Fax Number	:

Provider Business Practice Location Address
First Line	:	3805 W ALABAMA ST APT 3108
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5249
Country	:	US
Telephone Number	:	832-605-3264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/16/2011

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