Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | NE |
NPI | 1003488446 |
---|---|
Provider Name | Jacob Daniel O'neill |
First Address | Omaha, NE 68134-5368 |
Second Address | Elkhorn, NE 68022-5108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |