Healthcare Provider Details

I. General information

NPI: 1780617225
Provider Name (Legal Business Name): KONLIAN,O'NEILL & ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 11/12/2013
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 TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANICE BALDWIN
Title or Position: REGIONAL MANAGER OFFICE ADMIN
Credential:
Phone: 410-548-7600