Provider Demographics
NPI:1265670475
Name:O'MARA, KELLY ELEANOR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ELEANOR
Last Name:O'MARA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2806
Mailing Address - Country:US
Mailing Address - Phone:585-427-7610
Mailing Address - Fax:585-427-7410
Practice Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2806
Practice Address - Country:US
Practice Address - Phone:585-427-7610
Practice Address - Fax:585-427-7410
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist