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Individual

K MARIO MCNEILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRT, MMBT

Contact information

Practice address
2135 VALLEYGATE DR, SUITE 101, FAYETTEVILLE, NC 28304-3750
(910) 323-2247
(910) 486-8064
Mailing address
280 HILLS LN, ERWIN, NC 28339-8412
(919) 418-6686

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
NC
246ZE0500X
EEG Specialist/Technologist
NC
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
NC
2472E0500X
EEG Technician
NC

Other

Enumeration date
05/04/2009
Last updated
04/04/2012
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