Provider Demographics
NPI:1194011445
Name:DANIELS, ROBERT AREN (DPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:AREN
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 PINE LOG RD
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29851-3208
Mailing Address - Country:US
Mailing Address - Phone:803-270-8653
Mailing Address - Fax:
Practice Address - Street 1:1305 DANTIGNAC ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2774
Practice Address - Country:US
Practice Address - Phone:706-823-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0102902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic