Provider Demographics
NPI:1922302603
Name:MACDANIEL, PETER JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:MACDANIEL
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:PO BOX 866308
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75086-6308
Mailing Address - Country:US
Mailing Address - Phone:800-793-5464
Mailing Address - Fax:267-321-2099
Practice Address - Street 1:516 HERNDON PKWY
Practice Address - Street 2:STE D
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-6230
Practice Address - Country:US
Practice Address - Phone:703-478-0190
Practice Address - Fax:703-471-0247
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist