Provider Demographics
NPI:1528643392
Name:MCNALLY, ERIC P (DPT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:MCNALLY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 HAWTHORNE PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2901
Mailing Address - Country:US
Mailing Address - Phone:650-539-8912
Mailing Address - Fax:
Practice Address - Street 1:604 HAWTHORNE PL
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2901
Practice Address - Country:US
Practice Address - Phone:650-539-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist