Provider Demographics
NPI:1528199031
Name:MCNEILL, CAROLYN JANE (RPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JANE
Last Name:MCNEILL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-2429
Mailing Address - Country:US
Mailing Address - Phone:316-835-2128
Mailing Address - Fax:
Practice Address - Street 1:427 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3853
Practice Address - Country:US
Practice Address - Phone:316-283-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist