Provider Demographics
NPI:1245362573
Name:DANIELS, JEFF EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:JEFF
Middle Name:EDWARD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 MADISON CIR
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-7914
Mailing Address - Country:US
Mailing Address - Phone:423-623-7777
Mailing Address - Fax:423-623-0707
Practice Address - Street 1:413 W BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2219
Practice Address - Country:US
Practice Address - Phone:423-623-7777
Practice Address - Fax:423-623-0707
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT6689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist