MEDICARE: RANDALL MCNEALY II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	34703	FL

General Provider Information

NPI Number	:	1093651176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDALL MCNEALY II

Provider Business Mailing Address
First Line	:	4025 WIREGRASS DR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36301-9500
Country	:	US
Telephone Number	:	334-790-7630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 STRONG RD
Second Line	:
City	:	QUINCY
State	:	FL
Zip	:	32351-5249
Country	:	US
Telephone Number	:	334-790-7630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ RANDALL MCNEALY II ” Practice Location

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