Individual
MS. MIKKI L DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1901 MISSION 66, SUITE A, VICKSBURG, MS 39180-3711
(601) 638-4076
(601) 638-4979
Mailing address
5411 I 55 N, JACKSON, MS 39206-3616
(601) 940-5906
(601) 510-9012
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 3064
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000050976
BLUE CROSS BLUE SHIELD
MS
05
—
00121389
—
MS
01
—
7589031
AETNA
MS
Enumeration date
10/20/2006
Last updated
03/24/2016
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