Healthcare Provider Details

I. General information

NPI: 1437080793
Provider Name (Legal Business Name): ETHAN OLOUGHLIN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N HAYS ST
BEL AIR MD
21014-3650
US

IV. Provider business mailing address

1296 CLARIDGE CT
COATESVILLE PA
19320-4787
US

V. Phone/Fax

Practice location:
  • Phone: 410-989-3833
  • Fax:
Mailing address:
  • Phone: 610-719-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30866
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: