Provider Demographics
NPI:1043815871
Name:BLACKWELL, DANIELLE KATHLEEN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KATHLEEN
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 CAYDEN CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3229
Mailing Address - Country:US
Mailing Address - Phone:817-688-5635
Mailing Address - Fax:
Practice Address - Street 1:27330 OAK RIDGE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9042
Practice Address - Country:US
Practice Address - Phone:832-592-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT78492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer