Healthcare Provider Details

I. General information

NPI: 1710455381
Provider Name (Legal Business Name): DANIELS THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 S DIXIE DR STE L105
ST GEORGE UT
84770-7331
US

IV. Provider business mailing address

1664 S DIXIE DR STE L105
ST GEORGE UT
84770-7331
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-3707
  • Fax: 435-652-3750
Mailing address:
  • Phone: 435-652-3707
  • Fax: 435-652-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1366452880
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: RONALD KOLBY DANIELS
Title or Position: PRESIDENT
Credential: MHS, PT
Phone: 435-652-3707