MEDICARE: JAY O'NEAL MSPT

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	PT018762	PA

General Provider Information

NPI Number	:	1306039896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY O'NEAL MSPT

Provider Business Mailing Address
First Line	:	WEST GIRAD AVE AND 8TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123
Country	:	US
Telephone Number	:	215-787-2243
Fax Number	:

Provider Business Practice Location Address
First Line	:	4733 OSAGE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1814
Country	:	US
Telephone Number	:	267-977-1944
Fax Number	:

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

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/20/2007

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