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NPI Code Detail

MEDICARE: PATRICK WAYNE O'NEAL ATC

MEDICARE: PATRICK WAYNE O'NEAL ATC
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
12255A2300XAthletic Trainer1164SC

General Provider Information

NPI Number : 1982959227
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK WAYNE O'NEAL ATC
Provider Business Mailing Address
First Line : 429 N CHURCH ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-3612
Country : US
Telephone Number : 864-597-4449
Fax Number : 864-597-4484
Provider Business Practice Location Address
First Line : 429 N CHURCH ST
Second Line :
City : SPARTANBURG
State : SC
Zip : 29303-3612
Country : US
Telephone Number : 864-597-4449
Fax Number : 864-597-4484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2012
Last Update Date : 07/23/2012

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Directions to “ PATRICK WAYNE O'NEAL ATC” Practice Location

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