Provider Demographics
NPI:1144704297
Name:DANIELS, LAURA M (DPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:M
Last Name:DANIELS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:FENELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:121 GATEWAY RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5400
Mailing Address - Country:US
Mailing Address - Phone:843-796-3964
Mailing Address - Fax:843-796-4326
Practice Address - Street 1:121 GATEWAY RD UNIT B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5400
Practice Address - Country:US
Practice Address - Phone:843-796-3964
Practice Address - Fax:843-796-4326
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist