Provider Demographics
NPI:1104933951
Name:O'NEILL, LANEY VIRGINIA (MPT)
Entity type:Individual
Prefix:MRS
First Name:LANEY
Middle Name:VIRGINIA
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33650 6TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6754
Mailing Address - Country:US
Mailing Address - Phone:253-942-3308
Mailing Address - Fax:
Practice Address - Street 1:22659 PACIFIC HWY S
Practice Address - Street 2:SUITE 201
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5155
Practice Address - Country:US
Practice Address - Phone:206-824-3668
Practice Address - Fax:206-824-3964
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist