Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1207515 | TX |
NPI | 1043777659 |
---|---|
Provider Name | Kelsey Stewart O'meara |
First Address | Fort Worth, TX 76109-5037 |
Second Address | Fort Worth, TX 76107-7673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 01/03/2019 |