=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699080093
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT O'NEAL NORMILE PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2010
-----------------------------------------------------
Last Update Date | 08/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 MUNICIPAL DR STE 108
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-675-3012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8027 FOREST TRL
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-4126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-342-5624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 1147981
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------