Individual
DANA ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4681 COLLEGE PARK, ROUND ROCK, TX 78665-1526
(512) 663-0718
(512) 706-1956
Mailing address
1913 PAYNE AVE, AUSTIN, TX 78757-3203
(512) 785-5742
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2106556
TX
Other
Enumeration date
12/10/2014
Last updated
12/10/2014
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