Provider Demographics
NPI:1801236294
Name:POLK, DANIEL JR (RRT)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:POLK
Suffix:JR
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6519 ESCENA BLVD UNIT 1092
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4283
Mailing Address - Country:US
Mailing Address - Phone:469-371-4910
Mailing Address - Fax:
Practice Address - Street 1:6519 ESCENA BLVD UNIT 1092
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4283
Practice Address - Country:US
Practice Address - Phone:469-371-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723432279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health