Provider Demographics
NPI:1235697772
Name:O'NEILL, JEVIE LEE (DPT)
Entity Type:Individual
Prefix:
First Name:JEVIE
Middle Name:LEE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 DOMINION LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-6451
Mailing Address - Country:US
Mailing Address - Phone:757-576-7274
Mailing Address - Fax:
Practice Address - Street 1:1304 DOMINION LAKES BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6451
Practice Address - Country:US
Practice Address - Phone:757-576-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052096812251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics