Provider Demographics
NPI:1104600519
Name:PLOTCHER, COLLEEN (PTA)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:PLOTCHER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1311
Mailing Address - Country:US
Mailing Address - Phone:267-243-3445
Mailing Address - Fax:215-742-1871
Practice Address - Street 1:2127 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3216
Practice Address - Country:US
Practice Address - Phone:215-742-8099
Practice Address - Fax:215-742-1871
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1002677225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant