Provider Demographics
NPI:1316656200
Name:MCNEELY, BROOKE (LMT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 WALL BLVD APT 5-301
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7776
Mailing Address - Country:US
Mailing Address - Phone:504-335-9593
Mailing Address - Fax:
Practice Address - Street 1:3320 WALL BLVD APT 5-301
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7776
Practice Address - Country:US
Practice Address - Phone:504-335-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA9520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist