Healthcare Provider Details

I. General information

NPI: 1518312552
Provider Name (Legal Business Name): SEAN O'NEILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 DOVER GLEN CIR
ORLANDO FL
32828-7523
US

IV. Provider business mailing address

675 LONG LAKE DR
OVIEDO FL
32765-9112
US

V. Phone/Fax

Practice location:
  • Phone: 407-970-0824
  • Fax:
Mailing address:
  • Phone: 407-782-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 26554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: