Provider Demographics
NPI:1679919120
Name:MCDANIEL, LOUIS ANTHONY (LMT)
Entity type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:ANTHONY
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:609 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-4417
Mailing Address - Country:US
Mailing Address - Phone:318-282-1084
Mailing Address - Fax:
Practice Address - Street 1:609 JACKSON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4417
Practice Address - Country:US
Practice Address - Phone:318-282-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA6967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist