Provider Demographics
NPI:1851627079
Name:MACKIE, DANIEL WALLACE (PT, DPT, OCS)
Entity Type:Individual
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First Name:DANIEL
Middle Name:WALLACE
Last Name:MACKIE
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Gender:M
Credentials:PT, DPT, OCS
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Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:6768 HICKORY FLAT HWY
Practice Address - Street 2:STE 110
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9376
Practice Address - Country:US
Practice Address - Phone:770-721-5767
Practice Address - Fax:770-345-0158
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2016-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPT0098122251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic