Provider Demographics
NPI:1053640474
Name:CHOLERA, POONAM KRUNAL
Entity Type:Individual
Prefix:
First Name:POONAM
Middle Name:KRUNAL
Last Name:CHOLERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:APARTMENT-1714
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 BENJAMIN FRANKLIN PKWY
Practice Address - Street 2:APARTMENT-1714
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2735
Practice Address - Country:US
Practice Address - Phone:215-796-3985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist