Healthcare Provider Details

I. General information

NPI: 1881638757
Provider Name (Legal Business Name): GAIL LYNN ONEILL P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 HIGHLAND RD
HARTLAND MI
48353-2702
US

IV. Provider business mailing address

13998 MERRIE MEADOW LN
SOUTH LYON MI
48178-9174
US

V. Phone/Fax

Practice location:
  • Phone: 810-991-3300
  • Fax: 810-632-9535
Mailing address:
  • Phone: 248-486-0563
  • Fax: 248-486-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501002886
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: