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NPI Code Detail

MEDICARE: KELLY ELEANOR O'MARA PT, DPT

MEDICARE: KELLY ELEANOR O'MARA PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist030956NY

General Provider Information

NPI Number : 1265670475
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ELEANOR O'MARA PT, DPT
Provider Business Mailing Address
First Line : 3255 BRIGHTON HENRIETTA TOWN LINE RD
Second Line : SUITE 102
City : ROCHESTER
State : NY
Zip : 14623-2806
Country : US
Telephone Number : 585-427-7610
Fax Number : 585-427-7410
Provider Business Practice Location Address
First Line : 3255 BRIGHTON HENRIETTA TOWN LINE RD
Second Line : SUITE 102
City : ROCHESTER
State : NY
Zip : 14623-2806
Country : US
Telephone Number : 585-427-7610
Fax Number : 585-427-7410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2009
Last Update Date : 01/26/2009

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