Provider Demographics
NPI:1265792089
Name:MCNIEL, PHYLLIS F (CPO)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:F
Last Name:MCNIEL
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CALIFORNIA ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4281
Mailing Address - Country:US
Mailing Address - Phone:940-668-1118
Mailing Address - Fax:940-668-1123
Practice Address - Street 1:800 E CALIFORNIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4281
Practice Address - Country:US
Practice Address - Phone:940-668-1118
Practice Address - Fax:940-668-1123
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121OtherTEXAS BOARD OF ORTHOTICS/PROSTHETICS