Individual
MR. IAN MICHAEL MCNEILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CERT DN
Contact information
Practice address
1260 MARS HILL RD STE 115, WATKINSVILLE, GA 30677-4943
(706) 705-6110
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 497-0005
(706) 546-8792
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015528
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15380971
CAQH NUMBER
—
Enumeration date
08/19/2021
Last updated
12/03/2024
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