MEDICARE: OMER TARIQ PTA

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	225200000X	Physical Therapy Assistant	2306603364	VA

General Provider Information

NPI Number	:	1649514043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OMER TARIQ PTA

Provider Business Mailing Address
First Line	:	6822 KITE FLYER CT
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22150-3043
Country	:	US
Telephone Number	:	703-980-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	9160 BELVOIR WOODS PKWY
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-2703
Country	:	US
Telephone Number	:	703-781-2447
Fax Number	:	703-799-0189

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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