MEDICARE: EMILY RAE POMEROY PT, OCS, FAAOMPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	3111	OK

General Provider Information

NPI Number	:	1346275740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY RAE POMEROY PT, OCS, FAAOMPT

Provider Business Mailing Address
First Line	:	416 W 15TH ST
Second Line	:	SUITE 100
City	:	EDMOND
State	:	OK
Zip	:	73013-3747
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 W 15TH ST
Second Line	:	SUITE 100
City	:	EDMOND
State	:	OK
Zip	:	73013-3747
Country	:	US
Telephone Number	:	405-285-8477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/27/2009

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