Provider Demographics
NPI:1518195361
Name:MCDANIEL, JULIE MARIE (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:HEITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12121 BLUE RIDGE EXT
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-6401
Mailing Address - Country:US
Mailing Address - Phone:816-761-8088
Mailing Address - Fax:816-761-8923
Practice Address - Street 1:12121 BLUE RIDGE EXT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-6401
Practice Address - Country:US
Practice Address - Phone:816-761-8088
Practice Address - Fax:816-761-8923
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020652225100000X
KS11-04978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2868067OtherMEDICARE PTAN
46146046OtherBCBS-KC
MOMA4370015OtherMEDICARE PTAN
873215OtherOPTUM