Provider Demographics
NPI:1407810765
Name:MAYHAN, DANIEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MAYHAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8199 NAVARRE PKWY
Mailing Address - Street 2:# 12A
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-6941
Mailing Address - Country:US
Mailing Address - Phone:334-396-3273
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:525 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-1626
Practice Address - Country:US
Practice Address - Phone:334-312-1036
Practice Address - Fax:334-396-4905
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006199225100000X
FLPT22976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBBNBMedicare ID - Type UnspecifiedMEDICARE NUMBER