Provider Demographics
NPI:1639866189
Name:DANIEL, DOUGLAS BLAKE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BLAKE
Last Name:DANIEL
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8006 FENWICK LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-9528
Mailing Address - Country:US
Mailing Address - Phone:931-638-2398
Mailing Address - Fax:
Practice Address - Street 1:8006 FENWICK LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-9528
Practice Address - Country:US
Practice Address - Phone:931-638-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer