Provider Demographics
NPI:1023379187
Name:CAMINERO, OMAR (PTA)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:CAMINERO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 WINDORAH WAY
Mailing Address - Street 2:APT. B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1961
Mailing Address - Country:US
Mailing Address - Phone:561-623-7471
Mailing Address - Fax:
Practice Address - Street 1:1680 WINDORAH WAY
Practice Address - Street 2:APT. B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1961
Practice Address - Country:US
Practice Address - Phone:561-623-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 10214225200000X
MA2336225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant