Provider Demographics
NPI:1881195824
Name:O'NEAL, JALEESA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JALEESA
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S LAKE ST STE E
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-9376
Mailing Address - Country:US
Mailing Address - Phone:231-222-2121
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-5114
Practice Address - Country:US
Practice Address - Phone:231-536-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist