Provider Demographics
NPI:1902016983
Name:O'MARA, TODD (PT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:O'MARA
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 1:7280 LAGAE RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9452
Mailing Address - Country:US
Mailing Address - Phone:303-660-5349
Mailing Address - Fax:303-663-1715
Practice Address - Street 1:7280 LAGAE RD
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9452
Practice Address - Country:US
Practice Address - Phone:205-259-3991
Practice Address - Fax:205-876-8063
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
102255331OtherOWCP FACILITY ID
102255331OtherOWCP FACILITY ID
COC805017Medicare PIN