Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 004384 | WV |
NPI | 1083297618 |
---|---|
Provider Name | Winston Caleb O'neal |
First Address | Oak Hill, WV 25901-3009 |
Second Address | Oak Hill, WV 25901-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2021 |
Last Update Date | 02/05/2021 |