Healthcare Provider Details

I. General information

NPI: 1962880849
Provider Name (Legal Business Name): PATRICK O'NEIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 VANDALIA ST STE 105
SAINT PAUL MN
55114-1944
US

IV. Provider business mailing address

512 7TH ST NE
WASECA MN
56093-3200
US

V. Phone/Fax

Practice location:
  • Phone: 651-348-7428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11545
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: