Healthcare Provider Details

I. General information

NPI: 1699164814
Provider Name (Legal Business Name): ANGELA MCNEELY MS, ATC, LAT, CES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARDENNES ROAD C-8650
FORT LIBERTY NC
28310-0001
US

IV. Provider business mailing address

6540 BROOKSTONE LN APT 104
FAYETTEVILLE NC
28314-8054
US

V. Phone/Fax

Practice location:
  • Phone: 434-770-5798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126002191
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: