Provider Demographics
NPI:1598340267
Name:MCDANIEL, EMILY (PTA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 OLD CANTON RD APT 4804
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1250
Mailing Address - Country:US
Mailing Address - Phone:601-421-4565
Mailing Address - Fax:
Practice Address - Street 1:650A HIGHLAND COLONY PKWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-8000
Practice Address - Country:US
Practice Address - Phone:769-666-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA6479225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant