Provider Demographics
NPI:1679189351
Name:OMEGA SPORT PHYSICAL THERAPY AND PERFORMANCE LLC
Entity Type:Organization
Organization Name:OMEGA SPORT PHYSICAL THERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DELCAMBRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:210-254-4442
Mailing Address - Street 1:8034 VILLEFRANCHE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-6023
Mailing Address - Country:US
Mailing Address - Phone:210-254-4442
Mailing Address - Fax:
Practice Address - Street 1:5432 HOLLY RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4635
Practice Address - Country:US
Practice Address - Phone:210-254-4442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy