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General NPI Number Information
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NPI Number | 1043337264
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Entity Type | Individual
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Provider Name | PATRICIA O'MEARA MPT, NDT
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1701 E COLLEGE AVE
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2101
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Country | US
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Telephone | 309-664-3420
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Fax | 309-664-3422
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Provider Business Mailing Address
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Address Line | 2200 E WASHINGTON STREET
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City | BLOOMINGTON
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State | IL
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Zip | 61701
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Country | US
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Telephone | 309-664-3420
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Fax | 309-664-3422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070009905
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License Number State | IL
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