Provider Demographics
NPI:1306039896
Name:O'NEAL, JAY (MSPT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEST GIRAD AVE AND 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:215-787-2243
Mailing Address - Fax:
Practice Address - Street 1:4733 OSAGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-1814
Practice Address - Country:US
Practice Address - Phone:267-977-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist