Provider Demographics
NPI:1003885534
Name:DANIEL, DONALD HOUSTON (PT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:HOUSTON
Last Name:DANIEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1320
Mailing Address - Country:US
Mailing Address - Phone:229-446-1990
Mailing Address - Fax:229-446-1993
Practice Address - Street 1:2100 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1320
Practice Address - Country:US
Practice Address - Phone:229-446-1990
Practice Address - Fax:229-446-1993
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007010225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBCKJMedicare PIN
GAQ06655Medicare UPIN