Provider Demographics
NPI:1851501829
Name:DANIELS, SALLY EAKIN (PT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:EAKIN
Last Name:DANIELS
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 1:404 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2713
Mailing Address - Country:US
Mailing Address - Phone:740-392-4974
Mailing Address - Fax:
Practice Address - Street 1:11660 UPPER GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9084
Practice Address - Country:US
Practice Address - Phone:740-392-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2607225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist