MEDICARE: MR. BRYAN JOSEPH O'HALLORAN P.T. SCS, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-002907-E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	650015206	OTHER	PA	MEDICARE RAILROAD PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38720	OTHER	PA	BC/BS PIN
2	689220	OTHER	PA	UNITED HEALTHCARE PROV. #
4	0660220000	OTHER	PA	KEYSTONE PIN
5	0959942	OTHER	PA	AETNA HMO PROVIDER#
6	0660220000	OTHER	PA	PERSONALCHOICE PROVIDER #
7	5245562	OTHER	PA	AETNA TRADITIONAL PROV. #

General Provider Information

NPI Number	:	1295799914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN JOSEPH O'HALLORAN P.T. SCS, OCS

Provider Business Mailing Address
First Line	:	316 VALLEY RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-5434
Country	:	US
Telephone Number	:	610-789-1599
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 W EAGLE RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2234
Country	:	US
Telephone Number	:	610-789-9887
Fax Number	:	610-789-9883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	06/30/2010

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