1427406354 NPI number — JACQUELINE MCNEILL PAROLIN DPT

Table of content: JACQUELINE MCNEILL PAROLIN DPT (NPI 1427406354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427406354 NPI number — JACQUELINE MCNEILL PAROLIN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAROLIN
Provider First Name:
JACQUELINE
Provider Middle Name:
MCNEILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCNEILL
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427406354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 BERTONLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211-1501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-607-8461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9405 BRYANT FARMS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28277-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-207-2707
Provider Business Practice Location Address Fax Number:
980-207-2783
Provider Enumeration Date:
06/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  P16324 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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