Provider Demographics
NPI:1851627079
Name:MACKIE, DANIEL WALLACE (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WALLACE
Last Name:MACKIE
Suffix:
Gender:
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-497-0005
Mailing Address - Fax:
Practice Address - Street 1:6768 HICKORY FLAT HWY
Practice Address - Street 2:STE 110
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9376
Practice Address - Country:US
Practice Address - Phone:770-721-5767
Practice Address - Fax:770-345-0158
Is Sole Proprietor?:No
Enumeration Date:2009-10-22
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009812225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist