Individual
MRS. DANIELLE YASSALL
Active
Individual
MRS. DANIELLE YASSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1106482
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00802V
MEDICARE GROUP PROVIDER #
TX
01
—
164171401
MEDICAID GROUP PROVIDER #
TX
05
—
164175501
—
TX
01
—
31JC
BCBS GROUP PROVIDER #
TX
01
—
8T1439
BCBS INDIVIDUAL PROVIDER
TX
Enumeration date
02/06/2007
Last updated
07/29/2013
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