Provider Demographics
NPI:1396769329
Name:NEAL, JAY WALTER (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:WALTER
Last Name:NEAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 CANDLELIGHT CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20736-3616
Mailing Address - Country:US
Mailing Address - Phone:443-756-3029
Mailing Address - Fax:
Practice Address - Street 1:1875 CANDLELIGHT CT
Practice Address - Street 2:
Practice Address - City:OWINGS
Practice Address - State:MD
Practice Address - Zip Code:20736-3616
Practice Address - Country:US
Practice Address - Phone:443-756-3029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD432131600Medicaid
MD533439-05OtherBCBS INDIVIDUAL
MD533439-05OtherBCBS INDIVIDUAL