Provider Demographics
NPI:1396037065
Name:MCDANIEL, MARLENE E (PT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:E
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 CANYON DE FLORES
Mailing Address - Street 2:SUITE B
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-5380
Mailing Address - Country:US
Mailing Address - Phone:520-803-9727
Mailing Address - Fax:520-378-2683
Practice Address - Street 1:3455 CANYON DE FLORES
Practice Address - Street 2:SUITE B
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-5380
Practice Address - Country:US
Practice Address - Phone:520-803-9727
Practice Address - Fax:520-378-2683
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist