Healthcare Provider Details

I. General information

NPI: 1134196660
Provider Name (Legal Business Name): JEFFREY KEITH O'NEILL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 BAINBRIDGE ST
PHILADELPHIA PA
19147-1568
US

IV. Provider business mailing address

420 BAINBRIDGE ST
PHILADELPHIA PA
19147-1568
US

V. Phone/Fax

Practice location:
  • Phone: 215-629-1270
  • Fax: 215-629-1293
Mailing address:
  • Phone: 215-629-3837
  • Fax: 215-629-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: