Provider Demographics
NPI:1760721732
Name:O'NEAL, TIMOTHY BRANDT (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRANDT
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-3304
Mailing Address - Country:US
Mailing Address - Phone:803-973-0100
Mailing Address - Fax:803-973-0117
Practice Address - Street 1:1825 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2626
Practice Address - Country:US
Practice Address - Phone:803-949-5525
Practice Address - Fax:803-454-9459
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist