Provider Demographics
NPI:1720393655
Name:O'NEILL, REBERTA K (PTA)
Entity Type:Individual
Prefix:
First Name:REBERTA
Middle Name:K
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:K
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:5220 SW 17TH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-2500
Mailing Address - Country:US
Mailing Address - Phone:785-271-5533
Mailing Address - Fax:785-271-8818
Practice Address - Street 1:5220 SW 17TH ST
Practice Address - Street 2:STE 130
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-2500
Practice Address - Country:US
Practice Address - Phone:785-271-5533
Practice Address - Fax:785-271-8818
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02042225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant