Healthcare Provider Details

I. General information

NPI: 1487972899
Provider Name (Legal Business Name): CAROLINE MACNEILL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9441 LYNDON B JOHNSON FWY SUITE 101
DALLAS TX
75243
US

IV. Provider business mailing address

755 WOODLAKE DR
COPPELL TX
75019-2811
US

V. Phone/Fax

Practice location:
  • Phone: 214-575-9820
  • Fax:
Mailing address:
  • Phone: 972-745-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1048130
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: