Healthcare Provider Details

I. General information

NPI: 1093651176
Provider Name (Legal Business Name): RANDALL MCNEALY II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 STRONG RD
QUINCY FL
32351-5249
US

IV. Provider business mailing address

4025 WIREGRASS DR
DOTHAN AL
36301-9500
US

V. Phone/Fax

Practice location:
  • Phone: 334-790-7630
  • Fax:
Mailing address:
  • Phone: 334-790-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number34703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: