Provider Demographics
NPI:1568855245
Name:KEYES, DANIELLE (MED, ATC,LAT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KEYES
Suffix:
Gender:F
Credentials:MED, ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11743 NORTHPOINTE BLVD
Mailing Address - Street 2:UNIT 1027
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-5574
Mailing Address - Country:US
Mailing Address - Phone:904-338-8515
Mailing Address - Fax:
Practice Address - Street 1:14350 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-1665
Practice Address - Country:US
Practice Address - Phone:281-252-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer