MEDICARE: MR. DANIEL MAYHAN MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT006199	GA
2	225100000X	Physical Therapist	PT22976	FL

General Provider Information

NPI Number	:	1407810765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL MAYHAN MPT

Provider Business Mailing Address
First Line	:	8199 NAVARRE PKWY
Second Line	:	# 12A
City	:	NAVARRE
State	:	FL
Zip	:	32566-6941
Country	:	US
Telephone Number	:	334-396-3273
Fax Number	:	334-396-4905

Provider Business Practice Location Address
First Line	:	525 HOSPITAL DR
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36092-1626
Country	:	US
Telephone Number	:	334-312-1036
Fax Number	:	334-396-4905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/20/2016

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