Active NPI
Mikki L Daniel, PT
- Physical Therapist
- Vicksburg, MS
National Provider Identifier
1376625988
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 3064
- Practice address
- 1901 Mission 66
Suite a
Vicksburg, MS 39180-3711 - Phone
- (601) 638-4076
- Fax
- (601) 638-4979
- NPI assigned
- Oct 20, 2006
- Last updated
- Mar 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 3064 | MS | Primary |
Addresses
Primary practice location
1901 Mission 66
Suite a
Vicksburg, MS 39180-3711
Mailing address
5411 I 55 N
Jackson, MS 39206-3616
Phone (601) 940-5906
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00121389 | Medicaid | MS | |
| 7589031 | Other | MS | AETNA |
| 000050976 | Other | MS | BLUE CROSS BLUE SHIELD |
Other names 1
- Ms. Mikki L Daniel
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 3064 | MS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Good Samaritan Physical Therapy,Inc. | Past | Accepting new patients | |
| Inmotion Rehab LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Vicksburg, MS
- NPI 1023087855
-
- Physical Therapy Assistant
- Jackson, MS
- NPI 1801435334
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458777600000",
"number": "1376625988",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5411 I 55 N",
"city": "JACKSON",
"state": "MS",
"postal_code": "392063616",
"telephone_number": "601-940-5906",
"fax_number": "601-510-9012"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 MISSION 66",
"address_2": "SUITE A",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803711",
"telephone_number": "601-638-4076",
"fax_number": "601-638-4979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DANIEL",
"first_name": "MIKKI",
"middle_name": "L",
"name_prefix": "Ms.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-20",
"last_updated": "2016-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT 3064",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00121389",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7589031",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "000050976",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MIKKI",
"last_name": "DANIEL",
"middle_name": "L",
"prefix": "MS.",
"credential": "PT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.