MEDICARE: CARLOS O'NEAL PT

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
1	225100000X	Physical Therapist	10600	SC

General Provider Information

NPI Number	:	1154999472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS O'NEAL PT

Provider Business Mailing Address
First Line	:	141 ATRIUM WAY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-6301
Country	:	US
Telephone Number	:	803-957-0404
Fax Number	:	803-957-0468

Provider Business Practice Location Address
First Line	:	1787 S LAKE DR STE H
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-6736
Country	:	US
Telephone Number	:	803-957-0404
Fax Number	:	803-957-0468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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Directions to “ CARLOS O'NEAL PT” Practice Location

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