Provider Demographics
NPI:1558370403
Name:VERNON, MARILYN DANIELLE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:DANIELLE
Last Name:VERNON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:VERNON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1707 STONERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7812
Mailing Address - Country:US
Mailing Address - Phone:512-221-3448
Mailing Address - Fax:512-459-4195
Practice Address - Street 1:3212 TAMARRON BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-8011
Practice Address - Country:US
Practice Address - Phone:512-221-3448
Practice Address - Fax:512-593-7962
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11858892251X0800X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic