Provider Demographics
NPI:1376681932
Name:O'CONNOR, PATRICK D (PT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:D
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COLONIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3338
Mailing Address - Country:US
Mailing Address - Phone:610-544-4748
Mailing Address - Fax:
Practice Address - Street 1:203 E BALTIMORE AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3433
Practice Address - Country:US
Practice Address - Phone:610-565-0670
Practice Address - Fax:610-565-7706
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-011768-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA132405OtherBC/BS PIN
PA109846Q4GMedicare PIN