MEDICARE: MS. DEBORAH SAILOR DANIELS LMT

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	225700000X	Massage Therapist	2223	SC

General Provider Information

NPI Number	:	1497094239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH SAILOR DANIELS LMT

Provider Business Mailing Address
First Line	:	4736 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5616
Country	:	US
Telephone Number	:	843-444-9355
Fax Number	:	843-294-0019

Provider Business Practice Location Address
First Line	:	4304 PRINCETON DR
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7526
Country	:	US
Telephone Number	:	843-222-7352
Fax Number	:

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

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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