Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 1955 | SD |
NPI | 1386208734 |
---|---|
Provider Name | Kevin Andrew O'neil |
First Address | Sioux Falls, SD 57104-3701 |
Second Address | Sioux Falls, SD 57104-3701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 30/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033641352 | (05) | SD |