Provider Demographics
NPI:1902647092
Name:MCNEAL, JACOB GLENN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:GLENN
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
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Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12955 OLD MERIDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7106
Practice Address - Country:US
Practice Address - Phone:317-819-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05015572A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist