Provider Demographics
NPI:1124764709
Name:KILEY O'NEILL PT AND WELLNESS LLC
Entity type:Organization
Organization Name:KILEY O'NEILL PT AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:440-371-9109
Mailing Address - Street 1:3021 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6911
Mailing Address - Country:US
Mailing Address - Phone:440-371-9109
Mailing Address - Fax:757-720-4076
Practice Address - Street 1:3021 BEAVER DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6911
Practice Address - Country:US
Practice Address - Phone:440-371-9109
Practice Address - Fax:757-720-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy