Provider Demographics
NPI:1093338428
Name:O'MELIA, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:O'MELIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12570 OLD SEWARD HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3532
Mailing Address - Country:US
Mailing Address - Phone:907-222-2886
Mailing Address - Fax:907-222-2889
Practice Address - Street 1:12570 OLD SEWARD HWY STE 202
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3532
Practice Address - Country:US
Practice Address - Phone:907-222-2886
Practice Address - Fax:907-222-2889
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15038-24225100000X
AK175662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist