Provider Demographics
NPI:1861780728
Name:O'NEAL, STACEY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:911 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4207
Mailing Address - Country:US
Mailing Address - Phone:478-275-1800
Mailing Address - Fax:
Practice Address - Street 1:911 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4207
Practice Address - Country:US
Practice Address - Phone:478-275-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2013-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist