Provider Demographics
NPI:1568553774
Name:MCDANIEL, IAN P (PT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:P
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 E LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3993
Mailing Address - Country:US
Mailing Address - Phone:317-241-3200
Mailing Address - Fax:317-241-2535
Practice Address - Street 1:6855 SHORE TERRACE DR., STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-241-3200
Practice Address - Fax:317-241-2535
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007945A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5387109OtherAETNA
IN000000329344OtherBCBS
IN156529Medicare ID - Type Unspecified