Provider Demographics
NPI:1548513930
Name:MCNEALIS, JACLYN LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:LEIGH
Last Name:MCNEALIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 COVENANT CT
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-8726
Mailing Address - Country:US
Mailing Address - Phone:570-956-7798
Mailing Address - Fax:
Practice Address - Street 1:5520 COVENANT CT
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-8726
Practice Address - Country:US
Practice Address - Phone:570-956-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist