MEDICARE: DANIEL LEE STROADE PTA

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	225200000X	Physical Therapy Assistant	2078740	TX

General Provider Information

NPI Number	:	1851666705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL LEE STROADE PTA

Provider Business Mailing Address
First Line	:	7406 GENEVA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723
Country	:	US
Telephone Number	:	903-388-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY
Second Line	:	STE 201
City	:	HOUSTON
State	:	TX
Zip	:	77058-3310
Country	:	US
Telephone Number	:	713-532-6600
Fax Number	:

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

Provider Enumeration Date	:	03/11/2012
Last Update Date	:	03/11/2012

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