Healthcare Provider Details

I. General information

NPI: 1184395840
Provider Name (Legal Business Name): MEAGHAN O'LEARY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E WALNUT AVE
LOMPOC CA
93436-7027
US

IV. Provider business mailing address

805 E WALNUT AVE
LOMPOC CA
93436-7027
US

V. Phone/Fax

Practice location:
  • Phone: 805-735-3714
  • Fax:
Mailing address:
  • Phone: 805-735-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301073
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: