Provider Demographics
NPI:1235309311
Name:MCNEIL, PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:KEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:YUCCA
Mailing Address - State:AZ
Mailing Address - Zip Code:86438-0155
Mailing Address - Country:US
Mailing Address - Phone:928-279-3652
Mailing Address - Fax:888-446-5008
Practice Address - Street 1:11071 S. CAMELBACK ROAD
Practice Address - Street 2:
Practice Address - City:YUCCA
Practice Address - State:AZ
Practice Address - Zip Code:86438-0155
Practice Address - Country:US
Practice Address - Phone:928-279-3652
Practice Address - Fax:888-446-5008
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013680225100000X
AZ8596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ628701Medicaid