Provider Demographics
NPI:1578052684
Name:MCNEAL, REBECCA (MT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MCNEAL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 E ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6254
Mailing Address - Country:US
Mailing Address - Phone:907-745-4357
Mailing Address - Fax:907-745-4606
Practice Address - Street 1:108 E ARCTIC AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6254
Practice Address - Country:US
Practice Address - Phone:907-745-4357
Practice Address - Fax:907-745-4606
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
AK130914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist