MEDICARE: MR. DANIEL G MUNDORFF MPT

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	12861	SC

General Provider Information

NPI Number	:	1952055485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL G MUNDORFF MPT

Provider Business Mailing Address
First Line	:	119 BOYLE WAY
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-7847
Country	:	US
Telephone Number	:	610-389-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 ASHLEY RIVER RD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-5373
Country	:	US
Telephone Number	:	843-556-1745
Fax Number	:	843-556-3833

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	03/02/2026

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