Provider Demographics
NPI:1023524154
Name:OMALLEY, COREY MICHAEL (DPT, SCS, CSCS)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:MICHAEL
Last Name:OMALLEY
Suffix:
Gender:M
Credentials:DPT, SCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17306 SMOKEY POINT DR STE 19
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4707
Mailing Address - Country:US
Mailing Address - Phone:425-307-1335
Mailing Address - Fax:425-307-1422
Practice Address - Street 1:17306 SMOKEY POINT DR STE 19
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-4707
Practice Address - Country:US
Practice Address - Phone:425-307-1335
Practice Address - Fax:425-307-1422
Is Sole Proprietor?:No
Enumeration Date:2017-12-27
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT608198882251S0007X
WAOR2110722251X0800X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60819888OtherPT LICENSE
WAPT60819888OtherPT LICENSE
AZ486806712OtherPASSPORT