Provider Demographics
NPI:1780752667
Name:O'NEILL, REBECCA R (DPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1330
Mailing Address - Country:US
Mailing Address - Phone:931-837-2221
Mailing Address - Fax:
Practice Address - Street 1:550 N SPRING ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1330
Practice Address - Country:US
Practice Address - Phone:931-837-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014220610001Medicaid
PA1771606OtherHIGHMARK
PA268312OtherHEALTH AMERICA