Healthcare Provider Details

I. General information

NPI: 1215436332
Provider Name (Legal Business Name): DANIEL WATKINS MASSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2018
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 KEARNEY ST
HEMINGFORD NE
69348-8288
US

IV. Provider business mailing address

2800 ALLISON AVE
MANHATTAN KS
66502-7489
US

V. Phone/Fax

Practice location:
  • Phone: 308-760-2198
  • Fax:
Mailing address:
  • Phone: 308-760-2198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: