Provider Demographics
NPI:1972999274
Name:MCDANIELS, STEVEN ROBERT-VINCENT (LMT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT-VINCENT
Last Name:MCDANIELS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S GRAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3231
Mailing Address - Country:US
Mailing Address - Phone:352-460-7604
Mailing Address - Fax:
Practice Address - Street 1:718 S GRAND HWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3231
Practice Address - Country:US
Practice Address - Phone:352-460-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77229172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist