Provider Demographics
NPI:1093957540
Name:O'NEIL, TIFFANE BENNETT
Entity Type:Individual
Prefix:
First Name:TIFFANE
Middle Name:BENNETT
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANE
Other - Middle Name:M
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1107 NEW POINTE BLVD STE B6
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-4128
Mailing Address - Country:US
Mailing Address - Phone:910-399-1922
Mailing Address - Fax:866-844-3505
Practice Address - Street 1:1107 NEW POINTE BLVD STE B6
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4128
Practice Address - Country:US
Practice Address - Phone:910-399-1922
Practice Address - Fax:866-844-3505
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist