Individual provider Active NPI

Thomas Lee McDaniel, DPT

  • Physical Therapist
  • Grand Rapids, MI
National Provider Identifier
1104294859
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
55013038968 Issued in MI
Practice address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone
(616) 840-8000
NPI assigned
Sep 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PTH7678 AL
Physical Therapist 225100000X PT32572 FL
Physical Therapist 225100000X 55013038968 MI Primary

Addresses

Primary practice location

235 Wealthy St SE
Grand Rapids, MI 49503-5247

Mailing address

235 Wealthy St SE
Grand Rapids, MI 49503-5247
Phone (616) 840-8000

Other practice location 1

5643 Flume Dr
Pace, FL 32571-6425
Phone (772) 480-6846

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250514003648 MI Practitioner - Physical Therapist in Private Practice 6800218371 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTH7678ALMDPhysical Therapist
55013038968MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Free Bed Rehabilitation Hospital CurrentSince Jun 1, 2025 Accepting new patients
Mary Free Bed Rehabilitation Hospital CurrentSince Jun 1, 2025 Accepting new patients

Locations

235 Wealthy St SE
Grand Rapids, MI 49503
Phone (616) 242-0422

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1104294859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5643 Flume Dr",
            "address_purpose": "LOCATION",
            "city": "Pace",
            "state": "FL",
            "postal_code": "325716425",
            "country_code": "US",
            "telephone_number": "772-480-6846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDANIEL",
        "first_name": "THOMAS",
        "middle_name": "LEE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-11",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH7678",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT32572",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "55013038968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.