Provider Demographics
NPI:1124051727
Name:MCNALLY, JED S (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JED
Middle Name:S
Last Name:MCNALLY
Suffix:
Gender:
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 HIGHWAY 35 N
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3302
Mailing Address - Country:US
Mailing Address - Phone:361-729-2225
Mailing Address - Fax:361-729-2483
Practice Address - Street 1:203 CEDAR DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2900
Practice Address - Country:US
Practice Address - Phone:361-643-3993
Practice Address - Fax:361-687-2465
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1151595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2904OtherBLUE CROSS BLUE SHIELD
TX1721045-01Medicaid
TX1721045-01Medicaid