Provider Demographics
NPI:1881495216
Name:WILLIS, DANIEL J (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:WILLIS
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4247
Mailing Address - Country:US
Mailing Address - Phone:214-264-4253
Mailing Address - Fax:
Practice Address - Street 1:2696 N GALLOWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6363
Practice Address - Country:US
Practice Address - Phone:972-270-5555
Practice Address - Fax:972-270-7071
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1403087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist