Provider Demographics
NPI:1851321194
Name:TOLBERT, DANA DIANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:DIANNE
Last Name:TOLBERT
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 1:601 S BUCHTA RD
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4178
Mailing Address - Country:US
Mailing Address - Phone:979-848-1292
Mailing Address - Fax:
Practice Address - Street 1:117 CIRCLE WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5233
Practice Address - Country:US
Practice Address - Phone:979-480-9400
Practice Address - Fax:979-480-9410
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist