MEDICARE: KAYLA DANIELS PT, DPT, CBIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501017696	MI

General Provider Information

NPI Number	:	1306347406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DANIELS PT, DPT, CBIS

Provider Business Mailing Address
First Line	:	15328 NEHLS AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-2241
Country	:	US
Telephone Number	:	810-358-2553
Fax Number	:

Provider Business Practice Location Address
First Line	:	38257 MOUND RD BLDG D
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3466
Country	:	US
Telephone Number	:	313-278-4601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2018
Last Update Date	:	04/06/2022

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