Provider Demographics
NPI:1528589496
Name:DANIELSON, JACI (DPT)
Entity Type:Individual
Prefix:
First Name:JACI
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 ELDORADO PKWY # 102-20VM
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:972-681-1155
Mailing Address - Fax:972-681-3575
Practice Address - Street 1:3565 LAKOTA TRL
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5900
Practice Address - Country:US
Practice Address - Phone:214-592-0599
Practice Address - Fax:972-681-1155
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3121210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist