Individual
MR. EDWARD J O MARA III
Active
Individual
MR. EDWARD J O MARA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
DAPT0011118
PA
225100000X
Physical Therapist
Primary
PT011430L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0758283000
IBC
—
01
—
976930
HIGHMK
—
Enumeration date
11/29/2006
Last updated
07/08/2007
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