=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053471508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIM EILEEN MCNEAL P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 N ELM ST SUITE C
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76201-6905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-566-6645
-----------------------------------------------------
Fax | 940-566-6634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 TEJAS DR
-----------------------------------------------------
City | SANGER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76266-5011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-458-0380
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1061281
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------