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NPI Code Detail

MEDICARE: DR. SHANE JACOB O'MARA DPT

MEDICARE: DR. SHANE JACOB O'MARA 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 Therapist5501017719MI

General Provider Information

NPI Number : 1356799266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANE JACOB O'MARA DPT
Provider Business Mailing Address
First Line : 804 N WATER ST
Second Line :
City : BAY CITY
State : MI
Zip : 48708-5620
Country : US
Telephone Number : 989-450-3341
Fax Number :
Provider Business Practice Location Address
First Line : 2618 CENTER AVE
Second Line :
City : BAY CITY
State : MI
Zip : 48708-6300
Country : US
Telephone Number : 989-892-4557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2016
Last Update Date : 11/13/2024

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