Healthcare Provider Details

I. General information

NPI: 1780765552
Provider Name (Legal Business Name): LUCILLE MARIE O'NEIL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10124 W BROAD ST STE K
GLEN ALLEN VA
23060-3330
US

IV. Provider business mailing address

14177 STUART OAKS DR
GLEN ALLEN VA
23059-1666
US

V. Phone/Fax

Practice location:
  • Phone: 804-273-6656
  • Fax: 804-273-6612
Mailing address:
  • Phone: 804-798-6119
  • Fax: 804-273-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2305002498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: