Provider Demographics
NPI:1578167904
Name:O'NEILL, ANTHONY (PT, RDN, LMT)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:PT, RDN, LMT
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:513 FAIRFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3619
Mailing Address - Country:US
Mailing Address - Phone:706-414-2551
Mailing Address - Fax:
Practice Address - Street 1:7840 OLD REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-5106
Practice Address - Country:US
Practice Address - Phone:707-795-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004776133V00000X
GAMT005063225700000X
CA299469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist