Provider Demographics
NPI:1942073846
Name:OMDAL, FIONA ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:FIONA
Middle Name:ELIZABETH
Last Name:OMDAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:FIONA
Other - Middle Name:ELIZABETH
Other - Last Name:DALOIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 S CHERRY ST APT 475
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2755
Mailing Address - Country:US
Mailing Address - Phone:585-944-4141
Mailing Address - Fax:
Practice Address - Street 1:4500 E CHERRY CREEK SOUTH DR STE 710
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1534
Practice Address - Country:US
Practice Address - Phone:303-432-8487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014985225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant