Individual
MARK DANIELS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.A.T., M.S., A.T.C.
Contact information
Practice address
630 S ELM AVE, WEBSTER GROVES, MO 63119-4047
(417) 839-9920
Mailing address
630 S ELM AVE, WEBSTER GROVES, MO 63119-4047
(417) 839-9920
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
00036
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00036
LICENSED ATHLETIC TRAINER
MO
Enumeration date
06/07/2014
Last updated
06/07/2014
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