Provider Demographics
NPI:1891706420
Name:O'NEILL, DIANE K (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:K
Last Name:O'NEILL
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 1:3061 7TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265
Mailing Address - Country:US
Mailing Address - Phone:309-764-4729
Mailing Address - Fax:309-764-7144
Practice Address - Street 1:3061 7TH ST
Practice Address - Street 2:STE B
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-764-4729
Practice Address - Fax:309-764-7144
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK16253Medicare ID - Type Unspecified