Provider Demographics
NPI:1295167658
Name:NEAL, TIMOTHY ALVIN LEE (MS, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALVIN LEE
Last Name:NEAL
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-7898
Mailing Address - Country:US
Mailing Address - Phone:903-456-9366
Mailing Address - Fax:
Practice Address - Street 1:712 COLONY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-7898
Practice Address - Country:US
Practice Address - Phone:903-456-9366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT49742255A2300X
TX20000110002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer