Provider Demographics
NPI:1477596633
Name:MCNEIL, MICHAEL JR (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCNEIL
Suffix:JR
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 SECLUDED GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3331
Mailing Address - Country:US
Mailing Address - Phone:504-887-7463
Mailing Address - Fax:504-887-7115
Practice Address - Street 1:6820 VETERANS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-4494
Practice Address - Country:US
Practice Address - Phone:504-887-7463
Practice Address - Fax:504-887-7115
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04270R2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B717Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER