Provider Demographics
NPI:1659681898
Name:NEAL, MARK A (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:NEAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:151 N EAGLE CREEK DR
Mailing Address - Street 2:STE 400
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1889
Mailing Address - Country:US
Mailing Address - Phone:859-264-8866
Mailing Address - Fax:859-264-1167
Practice Address - Street 1:151 N EAGLE CREEK DR
Practice Address - Street 2:STE 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1889
Practice Address - Country:US
Practice Address - Phone:859-264-8866
Practice Address - Fax:859-264-1167
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY005703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist