Provider Demographics
NPI:1922498344
Name:MCNEAL, CRAIG ALLEN (MA60534573)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALLEN
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:MA60534573
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 56TH AVE SW APT NN106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7355
Mailing Address - Country:US
Mailing Address - Phone:303-591-9732
Mailing Address - Fax:
Practice Address - Street 1:9419 56TH AVE SW APT NN106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7355
Practice Address - Country:US
Practice Address - Phone:303-591-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60534573225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist