Provider Demographics
NPI:1306489992
Name:DANIEL, MANCEHELEN TISDALL (LMT)
Entity type:Individual
Prefix:
First Name:MANCEHELEN
Middle Name:TISDALL
Last Name:DANIEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 N COUNTY ROAD 27 APT E
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9460
Mailing Address - Country:US
Mailing Address - Phone:970-776-0597
Mailing Address - Fax:
Practice Address - Street 1:4207 N COUNTY ROAD 27 APT E
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9460
Practice Address - Country:US
Practice Address - Phone:970-776-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0020165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist