Healthcare Provider Details

I. General information

NPI: 1386562742
Provider Name (Legal Business Name): KENNETH MCDANIEL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S RURAL RD STE 5S
TEMPE AZ
85282-2444
US

IV. Provider business mailing address

2525 S RURAL RD STE 5S
TEMPE AZ
85282-2444
US

V. Phone/Fax

Practice location:
  • Phone: 480-921-9000
  • Fax: 480-718-8160
Mailing address:
  • Phone: 480-921-9000
  • Fax: 480-718-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number034848
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: