Healthcare Provider Details

I. General information

NPI: 1386252484
Provider Name (Legal Business Name): COREY M O'MALLEY PT, DPT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17306 SMOKEY POINT DR STE 19
ARLINGTON WA
98223-4707
US

IV. Provider business mailing address

12707 120TH AVE NE STE 100
KIRKLAND WA
98034-7500
US

V. Phone/Fax

Practice location:
  • Phone: 425-307-1335
  • Fax: 425-307-1422
Mailing address:
  • Phone: 480-201-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. COREY MICHAEL O'MALLEY
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT, SCS, CSCS
Phone: 425-307-1335