Provider Demographics
NPI:1295796605
Name:MCNERNEY, FAYE VENKLER (PT)
Entity type:Individual
Prefix:MRS
First Name:FAYE
Middle Name:VENKLER
Last Name:MCNERNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 BROKEN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4347
Mailing Address - Country:US
Mailing Address - Phone:937-335-4013
Mailing Address - Fax:
Practice Address - Street 1:2555 BROKEN WOODS DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-4347
Practice Address - Country:US
Practice Address - Phone:937-335-4013
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614979Medicaid