Provider Demographics
NPI:1861259087
Name:DANIELS, KERRA (LMT)
Entity type:Individual
Prefix:MRS
First Name:KERRA
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 W NORTH ST STE A517
Mailing Address - Street 2:
Mailing Address - City:PASS CHRISTIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39571-2605
Mailing Address - Country:US
Mailing Address - Phone:228-224-6602
Mailing Address - Fax:
Practice Address - Street 1:517 W NORTH ST STE C517
Practice Address - Street 2:
Practice Address - City:PASS CHRISTIAN
Practice Address - State:MS
Practice Address - Zip Code:39571-2605
Practice Address - Country:US
Practice Address - Phone:228-224-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2482225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist