MEDICARE: SHANNON MARIE 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	1172030	TX

General Provider Information

NPI Number	:	1568523520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MARIE O'NEAL PT

Provider Business Mailing Address
First Line	:	3070 BELLAIRE RANCH DR APT 614
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-1824
Country	:	US
Telephone Number	:	817-319-2930
Fax Number	:

Provider Business Practice Location Address
First Line	:	5950 BRYANT IRVIN RD
Second Line	:	SUITE 200
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4210
Country	:	US
Telephone Number	:	817-294-4646
Fax Number	:

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/26/2007

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