Provider Demographics
NPI:1477034767
Name:MCNEIL, JORDAN LYNN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LYNN
Last Name:MCNEIL
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 1:105 LUCKY CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4174
Mailing Address - Country:US
Mailing Address - Phone:512-665-5305
Mailing Address - Fax:
Practice Address - Street 1:1810 OLD GRANGER
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-3564
Practice Address - Country:US
Practice Address - Phone:512-352-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091003225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant