Healthcare Provider Details

I. General information

NPI: 1568853810
Provider Name (Legal Business Name): JENNA MCNEELY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W MAIN ST STE 212
RAPID CITY SD
57702-2446
US

IV. Provider business mailing address

2040 W MAIN ST STE 212
RAPID CITY SD
57702-2446
US

V. Phone/Fax

Practice location:
  • Phone: 605-716-7956
  • Fax: 605-716-7956
Mailing address:
  • Phone: 605-716-7956
  • Fax: 605-716-7956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1807
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: