Provider Demographics
NPI:1083712582
Name:DANIELS, SANDRA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8663 MIDDLEBROOK PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1612
Mailing Address - Country:US
Mailing Address - Phone:865-801-9380
Mailing Address - Fax:865-381-0707
Practice Address - Street 1:8663 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1612
Practice Address - Country:US
Practice Address - Phone:865-801-9380
Practice Address - Fax:865-381-0707
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT3090225100000X
TN3090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3650983Medicaid
TN4015383OtherBLUE CROSS BS
TN3650983Medicaid