Provider Demographics
NPI:1306261656
Name:DANIELS, KELLI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 WESTGATE PKWY STE 7
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-2154
Mailing Address - Country:US
Mailing Address - Phone:334-701-4800
Mailing Address - Fax:
Practice Address - Street 1:1314 WESTGATE PKWY STE 7
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2154
Practice Address - Country:US
Practice Address - Phone:334-701-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist