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General NPI Number Information
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NPI Number | 1780765552
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Entity Type | Individual
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Provider Name | LUCILLE MARIE O'NEIL PT
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Gender | Female
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 10124 W BROAD ST STE K
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City | GLEN ALLEN
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State | VA
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Zip | 23060-3330
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Country | US
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Telephone | 804-273-6656
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Fax | 804-273-6612
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Provider Business Mailing Address
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Address Line | 14177 STUART OAKS DR
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City | GLEN ALLEN
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State | VA
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Zip | 23059-1666
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Country | US
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Telephone | 804-798-6119
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Fax | 804-273-6656
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 2305002498
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License Number State | VA
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