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NPI Code Detail

MEDICARE: DANIELLE BLALOCK DPT

MEDICARE: DANIELLE BLALOCK DPT
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
1225100000XPhysical Therapist1289875TX

General Provider Information

NPI Number : 1871029793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE BLALOCK DPT
Provider Business Mailing Address
First Line : 205 HIDDEN SPRINGS DR
Second Line :
City : BASTROP
State : TX
Zip : 78602-2170
Country : US
Telephone Number : 512-308-7450
Fax Number : 512-321-1226
Provider Business Practice Location Address
First Line : 5401 LA CROSSE AVE BLDG C
Second Line :
City : AUSTIN
State : TX
Zip : 78739-2160
Country : US
Telephone Number : 512-852-8134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2017
Last Update Date : 10/18/2022

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