Provider Demographics
NPI:1073722658
Name:NEELEY, DANIELLE MARIE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:NEELEY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:MS
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:MULLENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:7001 BRYANT IRVIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-292-2662
Mailing Address - Fax:817-361-0614
Practice Address - Street 1:7001 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-292-2662
Practice Address - Fax:817-361-0614
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 8388225200000X
MEPA2885225200000X
IA00938225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant