Healthcare Provider Details

I. General information

NPI: 1801420062
Provider Name (Legal Business Name): KEELAN SIOBHAN OHARA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 W WARM SPRINGS RD STE 250
LAS VEGAS NV
89113-3646
US

IV. Provider business mailing address

8205 W WARM SPRINGS RD STE 250
LAS VEGAS NV
89113-3646
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-7498
  • Fax: 702-252-0369
Mailing address:
  • Phone: 702-294-7498
  • Fax: 702-252-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4205
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: