Provider Demographics
NPI:1407067630
Name:MCDANIEL, CAROL JOY (LMT, HTCP, CRMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JOY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:LMT, HTCP, CRMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 796
Mailing Address - Street 2:
Mailing Address - City:FT. COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80522-0796
Mailing Address - Country:US
Mailing Address - Phone:970-222-9421
Mailing Address - Fax:
Practice Address - Street 1:702 W. DRAKE ROAD, BUILDING E
Practice Address - Street 2:SUITE B102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526
Practice Address - Country:US
Practice Address - Phone:709-222-9421
Practice Address - Fax:970-797-1497
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist