Provider Demographics
NPI:1851430466
Name:YASSALL, DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:YASSALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:BERNAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:283 LOCKHAVEN DR STE 315
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-5519
Mailing Address - Country:US
Mailing Address - Phone:281-821-4200
Mailing Address - Fax:281-821-4880
Practice Address - Street 1:11275 S SAM HOUSTON PKWY W STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-2358
Practice Address - Country:US
Practice Address - Phone:832-328-4545
Practice Address - Fax:832-328-4548
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1106482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164175501Medicaid
TX31JCOtherBCBS GROUP PROVIDER #
TX00802VOtherMEDICARE GROUP PROVIDER #
TX8T1439OtherBCBS INDIVIDUAL PROVIDER
TX164171401OtherMEDICAID GROUP PROVIDER #
TX8B2191Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #