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NPI Code Detail

MEDICARE: JEVIE LEE O'NEILL DPT

MEDICARE:   JEVIE LEE O'NEILL  DPT
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
12251G0304XGeriatric Physical Therapist2305209681VA

General Provider Information

NPI Number : 1235697772
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEVIE LEE O'NEILL DPT
Provider Business Mailing Address
First Line : 1304 DOMINION LAKES BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-6451
Country : US
Telephone Number : 757-576-7274
Fax Number :
Provider Business Practice Location Address
First Line : 1304 DOMINION LAKES BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-6451
Country : US
Telephone Number : 757-576-7274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2019
Last Update Date : 03/04/2019

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