Provider Demographics
NPI:1528291143
Name:MCDANIEL, RITHA FAYE (RN, LMT)
Entity type:Individual
Prefix:
First Name:RITHA
Middle Name:FAYE
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:RITHA
Other - Middle Name:FAYE
Other - Last Name:MCDANIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-6328
Mailing Address - Country:US
Mailing Address - Phone:972-485-8759
Mailing Address - Fax:
Practice Address - Street 1:605 W STATE ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-6328
Practice Address - Country:US
Practice Address - Phone:972-485-8759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547955163WM1400X
TXMT107014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist