Healthcare Provider Details

I. General information

NPI: 1154326478
Provider Name (Legal Business Name): ANTHONY O'HARA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 05/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 E BUCK RD
PENNSBURG PA
18073-2327
US

IV. Provider business mailing address

1333 WHEATLAND AVE
PENNSBURG PA
18073-1134
US

V. Phone/Fax

Practice location:
  • Phone: 215-200-2144
  • Fax:
Mailing address:
  • Phone: 215-679-8965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT015712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: