Healthcare Provider Details

I. General information

NPI: 1497832927
Provider Name (Legal Business Name): TIMOTHY MICHAEL ONEAL PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 13TH STREET
ASHLAND KY
41102
US

IV. Provider business mailing address

PO BOX 1240
ASHLAND KY
41105
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-0910
  • Fax: 606-325-9848
Mailing address:
  • Phone: 606-325-7955
  • Fax: 606-325-9848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTAA01398
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA05465
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: