=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679965008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA O'NEAL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2015
-----------------------------------------------------
Last Update Date | 08/10/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 HIGROVE PKWY STE 125
-----------------------------------------------------
City | LEEDS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35094-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-699-1226
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2823 GREYSTONE COMMERCIAL BLVD
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-2660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-745-3660
-----------------------------------------------------
Fax | 205-745-3649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTH7499
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------