Provider Demographics
NPI:1760072367
Name:DANIELS, THEOTIS (DPT)
Entity Type:Individual
Prefix:
First Name:THEOTIS
Middle Name:
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 1:100 OKATIE CENTER BOULEVARD NORTH
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-3750
Mailing Address - Country:US
Mailing Address - Phone:843-547-4058
Mailing Address - Fax:843-705-7411
Practice Address - Street 1:100 OKATIE CENTER BOULEVARD NORTH
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3750
Practice Address - Country:US
Practice Address - Phone:843-547-4058
Practice Address - Fax:843-705-7411
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT10491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist