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General NPI Number Information
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NPI Number | 1205165198
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Entity Type | Individual
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Provider Name | CHRISTINE O'MEARA PT
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Gender | Female
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 1712 CHEHALIS DR
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City | PETALUMA
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State | CA
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Zip | 94954-2346
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Country | US
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Telephone | 707-849-9310
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Fax |
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Provider Business Mailing Address
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Address Line | 5 AZURITE CT
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City | PETALUMA
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State | CA
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Zip | 94952-5288
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Country | US
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Telephone |
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Fax |
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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 | 36212
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License Number State | CA
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