Provider Demographics
NPI:1447294400
Name:MCNAUGHTON, JOHN R (PTA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:MCNAUGHTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 ACTON HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-2948
Mailing Address - Country:US
Mailing Address - Phone:817-326-1375
Mailing Address - Fax:
Practice Address - Street 1:5310 ACTON HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-2948
Practice Address - Country:US
Practice Address - Phone:817-326-1375
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2042067225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W497Medicare ID - Type Unspecified