Individual provider Active NPI

Mary Kay Daniels, PTA

  • Physical Therapy Assistant
  • Navarre, FL
National Provider Identifier
1366612384
Registry record updated Mar 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA 19237 Issued in FL
Practice address
1921 Ortega St
Navarre, FL 32566-4111
Phone
(850) 936-8919
Fax
(850) 936-8936
NPI assigned
Mar 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA 19237 FL Primary

Addresses

Primary practice location

1921 Ortega St
Navarre, FL 32566-4111

Mailing address

1153 Gulf Breeze Pkwy
Gulf Breeze, FL 32561-4835
Phone (850) 932-6382

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA 19237FLMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabclinics SPT Inc Past Accepting new patients
Gulf Breeze Physical Therapy Inc. Past Accepting new patients

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": "1204675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1366612384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1153 GULF BREEZE PKWY",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325614835",
            "telephone_number": "850-932-6382",
            "fax_number": "850-932-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 ORTEGA ST",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325664111",
            "telephone_number": "850-936-8919",
            "fax_number": "850-936-8936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELS",
        "first_name": "MARY",
        "middle_name": "KAY",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-05",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA 19237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Navarre, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.