Basic Information
| Provider Information | |||||||||
| NPI: | 1780617225 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KONLIAN,O'NEILL & ASSOCIATES, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AQUACARE PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 659 S SALISBURY BLVD STE 1B | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106770700 | ||||||||
| FaxNumber: | 4106770883 | ||||||||
| Practice Location | |||||||||
| Address1: | 659 S SALISBURY BLVD STE 1B | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218015431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106770700 | ||||||||
| FaxNumber: | 4106770883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 11/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | BALDWIN | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REGIONAL MANAGER OFFICE ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 4105487600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 067112601 | 05 | MD | MEDICAID |