Provider Demographics
NPI:1104294859
Name:MCDANIEL, THOMAS LEE (DPT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:MCDANIEL
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5643 FLUME DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-6425
Mailing Address - Country:US
Mailing Address - Phone:772-480-6846
Mailing Address - Fax:
Practice Address - Street 1:5643 FLUME DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-6425
Practice Address - Country:US
Practice Address - Phone:772-480-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55013038968225100000X
ALPTH7678225100000X
FLPT32572225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist