Healthcare Provider Details

I. General information

NPI: 1225614449
Provider Name (Legal Business Name): COLLEEN MABLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 HAMILTON AVE
CINCINNATI OH
45231-2321
US

IV. Provider business mailing address

5654 WINDRIDGE DR
CINCINNATI OH
45248-1743
US

V. Phone/Fax

Practice location:
  • Phone: 513-931-5000
  • Fax:
Mailing address:
  • Phone: 513-382-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA012696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: