Provider Demographics
NPI:1174299101
Name:MACNEAL, KATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MACNEAL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 W MARINA BAY DR APT 202
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2328
Mailing Address - Country:US
Mailing Address - Phone:954-562-2358
Mailing Address - Fax:
Practice Address - Street 1:12040 S JOG RD STE 8
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:561-733-5083
Practice Address - Fax:561-733-5084
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT37279OtherSTATE LICENSE NUMBER