1316347768 NPI number — JOHN L. O'NEIL PT, DPT

Table of content: JUDY E HERBOLSHEIMER PA-C (NPI 1861480600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316347768 NPI number — JOHN L. O'NEIL PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEIL
Provider First Name:
JOHN
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316347768
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
826 WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
WESTMINSTER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21157-5750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-605-0505
Provider Business Mailing Address Fax Number:
443-605-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
826 WASHINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
WESTMINSTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21157-5750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-605-0505
Provider Business Practice Location Address Fax Number:
443-605-0506
Provider Enumeration Date:
09/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  25148 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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