Provider Demographics
NPI:1730278581
Name:MCDANIEL, LAURA TRACY (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:TRACY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3268 WELLONS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-672-9983
Mailing Address - Fax:252-672-9092
Practice Address - Street 1:3268 WELLONS BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-672-9983
Practice Address - Fax:252-672-9092
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7200100Medicaid
NC2503911AMedicare ID - Type Unspecified