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NPI Code Detail

MEDICARE: JENNIFER LYNN MCNALLY PTA

MEDICARE: JENNIFER LYNN MCNALLY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant3723NC

General Provider Information

NPI Number : 1063530095
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNN MCNALLY PTA
Provider Business Mailing Address
First Line : 11019 KING GEORGE LANE
Second Line :
City : WAXHAW
State : NC
Zip : 28173
Country : US
Telephone Number : 704-243-0660
Fax Number :
Provider Business Practice Location Address
First Line : 733 PLANTATION ESTATES DR
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-9116
Country : US
Telephone Number : 704-845-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 07/08/2007

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