Provider Demographics
NPI:1659979540
Name:DANIELS, NOLAN MICHAEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:MICHAEL
Last Name:DANIELS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5785 CENTENNIAL CENTER BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-7111
Mailing Address - Country:US
Mailing Address - Phone:702-916-7777
Mailing Address - Fax:702-916-2778
Practice Address - Street 1:3012 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9186
Practice Address - Country:US
Practice Address - Phone:702-916-2777
Practice Address - Fax:702-916-2778
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty