Provider Demographics
NPI:1447798335
Name:O'NEILL, SEAN (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E. FARWELL , STE. 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-8202
Mailing Address - Country:US
Mailing Address - Phone:509-465-2139
Mailing Address - Fax:509-465-2548
Practice Address - Street 1:309 E. FARWELL ,STE. 104
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8202
Practice Address - Country:US
Practice Address - Phone:509-465-2139
Practice Address - Fax:509-465-2548
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60722674225100000X
WAPT60722674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01853426OtherRR MEDICARE
OR1447798335Medicaid
WAP01853426OtherRR MEDICARE