Provider Demographics
NPI:1235703182
Name:DANIELS, MYIESHA (LMT)
Entity Type:Individual
Prefix:
First Name:MYIESHA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 OLANTA HWY LOT A
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-6574
Mailing Address - Country:US
Mailing Address - Phone:843-624-9602
Mailing Address - Fax:
Practice Address - Street 1:1422 OLANTA HWY LOT A
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541-6574
Practice Address - Country:US
Practice Address - Phone:843-624-9602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-15
Last Update Date:2021-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist