Provider Demographics
NPI:1457410573
Name:O'NEILL, GAIL DIANE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DIANE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BURNS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4360
Mailing Address - Country:US
Mailing Address - Phone:561-899-7747
Mailing Address - Fax:
Practice Address - Street 1:3375 BURNS RD STE 108
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4360
Practice Address - Country:US
Practice Address - Phone:561-899-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008007225100000X
NY007696-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT650001339Medicare PIN