MEDICARE: DR. LORI O'NEILL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P14271	NC

General Provider Information

NPI Number	:	1063538007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI O'NEILL PT

Provider Business Mailing Address
First Line	:	1029 BRYANT ST
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-3415
Country	:	US
Telephone Number	:	817-455-6278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 CLEARWATER LAKE RD
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27517-9186
Country	:	US
Telephone Number	:	817-455-6278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	11/28/2017

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