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General NPI Number Information
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NPI Number | 1700367059
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Entity Type | Individual
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Provider Name | JUDY ELAINE MCDANIEL PT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 3000 MOCKINGBIRD
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City | MIDLAND
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State | TX
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Zip | 79705-1608
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Country | US
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Telephone | 432-694-0077
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Fax |
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Provider Business Mailing Address
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Address Line | 3804 CRESTLINE AVE
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City | MIDLAND
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State | TX
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Zip | 79707-2723
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Country | US
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Telephone | 432-559-3493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1-5143-1
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License Number State | TX
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