Provider Demographics
NPI:1356601421
Name:DAIGLE, FELICIA C (DPT)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:C
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 E PFLUGERVILLE PKWY
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-8990
Practice Address - Country:US
Practice Address - Phone:512-259-6000
Practice Address - Fax:512-260-6005
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3111293225100000X
TX1218958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031DGOtherBLUE CROSS BLUE SHIELD
TX0944746-02Medicaid
TX0031DGOtherBLUE CROSS BLUE SHIELD