Provider Demographics
NPI:1982049771
Name:MCDANIEL, TAMARA MARCHELL (PTA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARCHELL
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8831 RACE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4605
Mailing Address - Country:US
Mailing Address - Phone:720-431-6108
Mailing Address - Fax:
Practice Address - Street 1:7481 KNOX PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4818
Practice Address - Country:US
Practice Address - Phone:303-427-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA-0499225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPTA-0499OtherPTA LICENSURE