Provider Demographics
NPI:1063538007
Name:O'NEILL, LORI (PT)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3415
Mailing Address - Country:US
Mailing Address - Phone:817-455-6278
Mailing Address - Fax:
Practice Address - Street 1:1621 CLEARWATER LAKE RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9186
Practice Address - Country:US
Practice Address - Phone:817-455-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist