Provider Demographics
NPI:1124870258
Name:O'NEILL, DALE ELLEN (PT, MS)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:ELLEN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2221
Mailing Address - Country:US
Mailing Address - Phone:508-801-0895
Mailing Address - Fax:
Practice Address - Street 1:78 FISHER ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2221
Practice Address - Country:US
Practice Address - Phone:508-801-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist