Provider Demographics
NPI:1386252484
Name:COREY M O'MALLEY PT, DPT, PLLC
Entity type:Organization
Organization Name:COREY M O'MALLEY PT, DPT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, SCS, CSCS
Authorized Official - Phone:425-307-1335
Mailing Address - Street 1:12707 120TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7500
Mailing Address - Country:US
Mailing Address - Phone:480-201-9227
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023524154OtherNPI FOR COREY O'MALLEY
WAPT60819888OtherWA STATE PT LICENSE
WA2094172Medicaid