Provider Demographics
NPI:1235486010
Name:NEAL, PAULA N (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:N
Last Name:NEAL
Suffix:
Gender:F
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 FGCU BLVD S
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33965-6502
Mailing Address - Country:US
Mailing Address - Phone:239-745-4299
Mailing Address - Fax:239-590-7398
Practice Address - Street 1:10501 FGCU BLVD S
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6502
Practice Address - Country:US
Practice Address - Phone:239-745-4299
Practice Address - Fax:239-590-7398
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer