Provider Demographics
NPI:1568054328
Name:BUCIO, DANIELA COSTA
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:COSTA
Last Name:BUCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 ALLIANCE BLVD # 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5504
Mailing Address - Country:US
Mailing Address - Phone:469-606-1378
Mailing Address - Fax:469-606-1383
Practice Address - Street 1:4825 ALLIANCE BLVD # 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5504
Practice Address - Country:US
Practice Address - Phone:469-606-1378
Practice Address - Fax:469-606-1383
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1307258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist