Provider Demographics
NPI:1154996122
Name:MCNEIL, SHONDA RENEE (PTA)
Entity type:Individual
Prefix:
First Name:SHONDA
Middle Name:RENEE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 COUNTY ROAD 4755
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-8274
Mailing Address - Country:US
Mailing Address - Phone:903-575-7672
Mailing Address - Fax:
Practice Address - Street 1:617 COUNTY ROAD 4755
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-8274
Practice Address - Country:US
Practice Address - Phone:903-575-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2160135225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant