Healthcare Provider Details

I. General information

NPI: 1043337264
Provider Name (Legal Business Name): PATRICIA O'MEARA MPT, NDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E COLLEGE AVE
BLOOMINGTON IL
61704-2101
US

IV. Provider business mailing address

2200 E WASHINGTON STREET
BLOOMINGTON IL
61701
US

V. Phone/Fax

Practice location:
  • Phone: 309-664-3420
  • Fax: 309-664-3422
Mailing address:
  • Phone: 309-664-3420
  • Fax: 309-664-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070009905
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: