Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305209681 | VA |
NPI | 1235697772 |
---|---|
Provider Name | Jevie Lee O'neill |
First Address | Chesapeake, VA 23320-6451 |
Second Address | Chesapeake, VA 23320-6451 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |