Healthcare Provider Details

I. General information

NPI: 1730291444
Provider Name (Legal Business Name): JENNIFER O'NEILL MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5431
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5431
US

V. Phone/Fax

Practice location:
  • Phone: 410-677-0700
  • Fax: 410-677-0883
Mailing address:
  • Phone: 410-677-0700
  • Fax: 410-677-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: