Provider Demographics
NPI:1053471508
Name:MCNEAL, KIM EILEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:EILEEN
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TEJAS DR
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-5011
Mailing Address - Country:US
Mailing Address - Phone:940-458-0380
Mailing Address - Fax:
Practice Address - Street 1:1010 N ELM ST
Practice Address - Street 2:SUITE C
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6905
Practice Address - Country:US
Practice Address - Phone:940-566-6645
Practice Address - Fax:940-566-6634
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1061281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist