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General NPI Number Information
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NPI Number | 1639790090
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Entity Type | Individual
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Provider Name | BROCK O'NEAL PT, DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 09/27/2025
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Provider Practice Location Address
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Address Line | 1150 GRAHAM RD STE 104
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City | FLORISSANT
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State | MO
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Zip | 63031-8077
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Country | US
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Telephone | 314-953-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 8986 BROMDEN LN E APT 103
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City | MEMPHIS
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State | TN
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Zip | 38125-1155
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Country | US
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Telephone | 573-768-1415
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15111
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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