Provider Demographics
NPI:1740417781
Name:WASHBURN, DACIANA LYN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DACIANA
Middle Name:LYN
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22102 BRIDGESTONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3152
Mailing Address - Country:US
Mailing Address - Phone:832-928-2857
Mailing Address - Fax:832-296-6625
Practice Address - Street 1:22102 BRIDGESTONE OAK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3152
Practice Address - Country:US
Practice Address - Phone:832-928-2857
Practice Address - Fax:832-296-6625
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist