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General NPI Number Information
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NPI Number | 1093338428
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Entity Type | Individual
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Provider Name | SAMUEL O'MELIA
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Gender | Male
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Dates
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Enumeration Date | 05/20/2020
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 11430 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-3414
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Country | US
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Telephone | 262-518-1900
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Fax | 262-518-1922
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Provider Business Mailing Address
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Address Line | 11430 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-3414
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Country | US
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Telephone | 262-518-1900
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Fax | 262-518-1922
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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 | 175662
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 15038-24
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License Number State | WI
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