MEDICARE: TEODORA OMANA

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
1	225100000X	Physical Therapist	10115	NC

General Provider Information

NPI Number	:	1356554737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEODORA OMANA

Provider Business Mailing Address
First Line	:	1926 ROBINWOOD RD APT I
Second Line	:	HUDSON WOODS APARTMENTS
City	:	GASTONIA
State	:	NC
Zip	:	28054-1642
Country	:	US
Telephone Number	:	704-678-4029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1926 ROBINWOOD RD APT I
Second Line	:	HUDSON WOODS APARTMENTS
City	:	GASTONIA
State	:	NC
Zip	:	28054-1642
Country	:	US
Telephone Number	:	704-678-4029
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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