MEDICARE: DANIEL JEROME P.T.

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	05009899A	IN
2	225100000X	Physical Therapist	1333218	TX

General Provider Information

NPI Number	:	1962744979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JEROME P.T.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 W SLAUGHTER LN STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-4015
Country	:	US
Telephone Number	:	512-654-4000
Fax Number	:	512-654-4001

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	03/03/2026

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