Jed S. McNally, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Portland, TX
NPI 1124051727 · NPPES record last updated Feb 26, 2025
Key facts
- NPI
- 1124051727
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1151595 (TX)
- Practice address
- 203 Cedar Dr
Portland, TX 78374-2900 - Phone
- (361) 643-3993
- Fax
- (361) 687-2465
- NPI assigned
- Jul 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Texas Sports Medicine Inc
Practice addresses (Care Compare)
203 Cedar Dr
Portland, TX 78374-2900
Phone (361) 643-3993
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050318000031 | TX | Practitioner - Physical Therapist in Private Practice | 8628023090 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1151595 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Texas Sports Medicine Inc | Physical Therapist | Current |
Accepting new patients |
| South Texas Sports Medicine Inc | Physical Therapist | Current | Accepting new patients |
| South Texas Sports Medicine Inc | Current |
Accepting new patients |
Locations
5530 Lipes Blvd
Corpus Christi, TX 78413
Phone (361) 993-9494
203 Cedar Dr
Portland, TX 78374
Phone (361) 643-3993
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1151595 | TX | Yes |
Addresses
Primary practice location
203 Cedar Dr
Portland, TX 78374-2900
Mailing address
2011 Highway 35 N
Rockport, TX 78382-3302
Phone (361) 729-2225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T2904 | Other | TX | BLUE CROSS BLUE SHIELD |
| 1721045-01 | Medicaid | TX |
Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.