Provider Demographics
NPI:1255386918
Name:OMER, LINDA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANN
Last Name:OMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:PARDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:428 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240
Mailing Address - Country:US
Mailing Address - Phone:606-789-5846
Mailing Address - Fax:606-789-5876
Practice Address - Street 1:428 SECOND STREET
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-5846
Practice Address - Fax:606-789-5876
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY000466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136OtherCHA
000000187117OtherANTHEM
2136OtherCHA