Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT32721 | CA |
NPI | 1053348805 |
---|---|
Provider Name | Jaclynn Mcneill |
First Address | Novato, CA 94947-3833 |
Second Address | Novato, CA 94947-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 25/06/2008 |