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NPI Code Detail

MEDICARE: JACOB DANIEL O'NEILL

MEDICARE: JACOB DANIEL O'NEILL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantNE

General Provider Information

NPI Number : 1003488446
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB DANIEL O'NEILL
Provider Business Mailing Address
First Line : 2671 N 97TH ST
Second Line :
City : OMAHA
State : NE
Zip : 68134-5368
Country : US
Telephone Number : 402-714-5621
Fax Number :
Provider Business Practice Location Address
First Line : 20800 W MAPLE RD
Second Line :
City : ELKHORN
State : NE
Zip : 68022-5108
Country : US
Telephone Number : 866-748-3655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2021
Last Update Date : 07/14/2021

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