Mark Daniels, L.A.T., M.S., A.T.C.
Individual provider Active NPI Specialist · Webster Groves, MO
NPI 1205249257 · NPPES record last updated Jun 7, 2014
Key facts
- NPI
- 1205249257
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 00036 (MO)
- Practice address
- 630 S Elm Ave
Webster Groves, MO 63119-4047 - Phone
- (417) 839-9920
- NPI assigned
- Jun 7, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00036 | MO | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 00036 | MO | Yes |
Addresses
Primary practice location
630 S Elm Ave
Webster Groves, MO 63119-4047
Mailing address
630 S Elm Ave
Webster Groves, MO 63119-4047
Phone (417) 839-9920
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00036 | Other | MO | LICENSED ATHLETIC TRAINER |
Other providers in Webster Groves, MO
- Cornerstone Therapy Services
- Chera Craig
- Jessica Dawn Crump
- Peter McKnight Crump
- Dale Kuhn Consulting LLC
- Neal Thomas Decosta
- Anne Marie Delaplain
- Aimee Dempsey
- Denise S Plaisance DCPC
- Diversified Counseling, LLC
All providers in Webster Groves, MO · Specialist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.