Provider Demographics
NPI:1174179196
Name:O'NEAL, CHRISTOPHER JASON
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JASON
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7828
Mailing Address - Country:US
Mailing Address - Phone:225-921-4695
Mailing Address - Fax:
Practice Address - Street 1:11425 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-7828
Practice Address - Country:US
Practice Address - Phone:225-921-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant