MEDICARE: MR. JED S. MCNALLY PHYSICAL THERAPIST

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	225100000X	Physical Therapist	1151595	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T2904	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124051727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JED S. MCNALLY PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	2011 HIGHWAY 35 N
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382-3302
Country	:	US
Telephone Number	:	361-729-2225
Fax Number	:	361-729-2483

Provider Business Practice Location Address
First Line	:	203 CEDAR DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2900
Country	:	US
Telephone Number	:	361-643-3993
Fax Number	:	361-687-2465

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	02/26/2025

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