Healthcare Provider Details

I. General information

NPI: 1104600519
Provider Name (Legal Business Name): COLLEEN PLOTCHER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 RHAWN ST
PHILADELPHIA PA
19152-3216
US

IV. Provider business mailing address

823 GLENN ST
PHILA PA
19115-1311
US

V. Phone/Fax

Practice location:
  • Phone: 215-742-8099
  • Fax: 215-742-1871
Mailing address:
  • Phone: 267-243-3445
  • Fax: 215-742-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1002677
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: