Provider Demographics
NPI:1366164584
Name:MCDANIEL MCQUADE, RESTONA
Entity type:Individual
Prefix:
First Name:RESTONA
Middle Name:
Last Name:MCDANIEL MCQUADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HORROCK STATION RD
Mailing Address - Street 2:
Mailing Address - City:RENICK
Mailing Address - State:WV
Mailing Address - Zip Code:24966-3103
Mailing Address - Country:US
Mailing Address - Phone:304-667-1660
Mailing Address - Fax:
Practice Address - Street 1:10434 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1586
Practice Address - Country:US
Practice Address - Phone:304-645-1706
Practice Address - Fax:304-645-4085
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant