Provider Demographics
NPI:1972016368
Name:MCNEAL, PEPE C
Entity type:Individual
Prefix:MR
First Name:PEPE
Middle Name:C
Last Name:MCNEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 N RENFREW PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2314
Mailing Address - Country:US
Mailing Address - Phone:813-389-1318
Mailing Address - Fax:
Practice Address - Street 1:15241 NORTH DALEMABRY AVE
Practice Address - Street 2:SOLA SALONS (STUDIO #14
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-389-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL11936161744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management