Healthcare Provider Details

I. General information

NPI: 1154279727
Provider Name (Legal Business Name): DAKOTA MCDANIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 UNION UNIVERSITY DR STE G
JACKSON TN
38305-3714
US

IV. Provider business mailing address

1743 HURON RD
HURON TN
38345-6939
US

V. Phone/Fax

Practice location:
  • Phone: 865-406-7675
  • Fax:
Mailing address:
  • Phone: 731-249-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16695
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: