Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | PT018102 | PA |
NPI | 1164620118 |
---|---|
Provider Name | Dr. Colleen S Ohara |
First Address | Philadelphia, PA 19147-1568 |
Second Address | King Of Prussia, PA 19406-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 10/07/2007 |