Provider Demographics
NPI:1689218596
Name:SPAULDING, DANIEL DOUGLAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DOUGLAS
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12885 RESEARCH BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3224
Mailing Address - Country:US
Mailing Address - Phone:512-640-9965
Mailing Address - Fax:
Practice Address - Street 1:2301 E RIVERSIDE DR BLDG A-50
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3167
Practice Address - Country:US
Practice Address - Phone:512-640-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1326071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist