Provider Demographics
NPI:1336308212
Name:OMBRELLO, JAMES MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:OMBRELLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 MILLROCK DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5589
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6440 MILLROCK DR
Practice Address - Street 2:SUITE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5589
Practice Address - Country:US
Practice Address - Phone:866-724-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2876225100000X
TX1166960225100000X
AK1937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist