Provider Demographics
NPI:1346001245
Name:GARRETT, DANIEL KELLY (LMT, LPTA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KELLY
Last Name:GARRETT
Suffix:
Gender:M
Credentials:LMT, LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-4529
Mailing Address - Country:US
Mailing Address - Phone:334-372-5966
Mailing Address - Fax:
Practice Address - Street 1:1305 S BRUNDIDGE ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3136
Practice Address - Country:US
Practice Address - Phone:334-372-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6310225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty