Provider Demographics
NPI:1700522216
Name:EASLEY, DANIEL FORREST
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:FORREST
Last Name:EASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 ANNA LEE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-1121
Mailing Address - Country:US
Mailing Address - Phone:408-460-5058
Mailing Address - Fax:
Practice Address - Street 1:1687 ANNA LEE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-1121
Practice Address - Country:US
Practice Address - Phone:408-460-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer