Provider Demographics
NPI:1568648491
Name:O'NEIL, KIM GARRISS (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:GARRISS
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMERSET GRN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-7168
Mailing Address - Country:US
Mailing Address - Phone:615-662-9018
Mailing Address - Fax:
Practice Address - Street 1:275 JACKSON MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1453
Practice Address - Country:US
Practice Address - Phone:615-885-7848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist