Basic Information
| Provider Information | |||||||||
| NPI: | 1578141990 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | COLLEEN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6824 TERRY DR | ||||||||
| Address2: | |||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319052758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147966746 | ||||||||
| FaxNumber: | 7194958685 | ||||||||
| Practice Location | |||||||||
| Address1: | 6298 VETERANS PKWY STE 5A | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319096245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194880120 | ||||||||
| FaxNumber: | 7194881427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2021 | ||||||||
| LastUpdateDate: | 05/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL.0017520 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT015796 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.