MEDICARE: MR. DANIEL PAUL MIDYETT SR.

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	00696	LA

General Provider Information

NPI Number	:	1821810821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL PAUL MIDYETT SR.

Provider Business Mailing Address
First Line	:	307 INTERNATIONAL CIR STE 100
Second Line	:
City	:	COCKEYSVILLE
State	:	MD
Zip	:	21030-1387
Country	:	US
Telephone Number	:	225-924-2851
Fax Number	:

Provider Business Practice Location Address
First Line	:	9301 OXFORD PLACE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2557
Country	:	US
Telephone Number	:	318-423-6848
Fax Number	:

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

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	10/30/2024

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