Healthcare Provider Details

I. General information

NPI: 1043407257
Provider Name (Legal Business Name): ELIZABETH ANN OMALLEY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E ASHMAN ST
MIDLAND MI
48642-4505
US

IV. Provider business mailing address

810 E ASHMAN ST
MIDLAND MI
48642-4505
US

V. Phone/Fax

Practice location:
  • Phone: 989-486-1232
  • Fax:
Mailing address:
  • Phone: 989-486-1232
  • Fax: 989-837-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: