Provider Demographics
NPI:1578776522
Name:MCNEILL, LESLIE ALEC (LPTA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ALEC
Last Name:MCNEILL
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SUMMERTON CT
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-3755
Mailing Address - Country:US
Mailing Address - Phone:608-825-2105
Mailing Address - Fax:
Practice Address - Street 1:41 RICKEL RD
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1840
Practice Address - Country:US
Practice Address - Phone:608-825-3242
Practice Address - Fax:608-837-9484
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI635-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40371400Medicaid