MEDICARE: JENNA MCNEELY PT, DPT

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
1	2251P0200X	Pediatric Physical Therapist	1807	SD

General Provider Information

NPI Number	:	1568853810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MCNEELY PT, DPT

Provider Business Mailing Address
First Line	:	2040 W MAIN ST STE 212
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2446
Country	:	US
Telephone Number	:	605-716-7956
Fax Number	:	605-716-7956

Provider Business Practice Location Address
First Line	:	2040 W MAIN ST STE 212
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2446
Country	:	US
Telephone Number	:	605-716-7956
Fax Number	:	605-716-7956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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