Provider Demographics
NPI:1235327370
Name:DANIEL, JESSICA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 LAKE WOODLANDS DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2566
Mailing Address - Country:US
Mailing Address - Phone:281-364-1122
Mailing Address - Fax:281-210-2446
Practice Address - Street 1:6767 LAKE WOODLANDS DR
Practice Address - Street 2:SUITE F
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2566
Practice Address - Country:US
Practice Address - Phone:281-364-1122
Practice Address - Fax:281-210-2446
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1175691OtherLICENSE