Healthcare Provider Details

I. General information

NPI: 1902016983
Provider Name (Legal Business Name): TODD O'MARA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD
CASTLE PINES CO
80108-9452
US

IV. Provider business mailing address

7280 LAGAE RD
CASTLE PINES CO
80108-9452
US

V. Phone/Fax

Practice location:
  • Phone: 205-259-3991
  • Fax: 205-876-8063
Mailing address:
  • Phone: 303-660-5349
  • Fax: 303-663-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6907
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: