Provider Demographics
NPI:1376739839
Name:CORELLA, COLLEEN K (MPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:K
Last Name:CORELLA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:K
Other - Last Name:SCHORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:1605 HAMPDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1601
Mailing Address - Country:US
Mailing Address - Phone:610-372-7139
Mailing Address - Fax:
Practice Address - Street 1:1940 N 13TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1539
Practice Address - Country:US
Practice Address - Phone:610-921-0609
Practice Address - Fax:610-921-2652
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008178L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist