Basic Information
| Provider Information | |||||||||
| NPI: | 1891392411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCDANIEL | ||||||||
| FirstName: | RODNEY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3726 BROADWAY STE 104 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252764308 | ||||||||
| FaxNumber: | 4252524477 | ||||||||
| Practice Location | |||||||||
| Address1: | 3726 BROADWAY STE 104 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982013787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252764308 | ||||||||
| FaxNumber: | 4252524477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2020 | ||||||||
| LastUpdateDate: | 10/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 61044057 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.