Basic Information
| Provider Information | |||||||||
| NPI: | 1902016983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'MARA | ||||||||
| FirstName: | TODD | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7280 LAGAE RD | ||||||||
| Address2: | |||||||||
| City: | CASTLE PINES | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801089452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036605349 | ||||||||
| FaxNumber: | 3036631715 | ||||||||
| Practice Location | |||||||||
| Address1: | 7280 LAGAE RD | ||||||||
| Address2: | |||||||||
| City: | CASTLE PINES | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801089452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052593991 | ||||||||
| FaxNumber: | 2058768063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6907 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 102255331 | 01 | OWCP FACILITY ID | OTHER |