Provider Demographics
NPI:1376945097
Name:HARCHUCK, COLLEEN PATRICIA (MPT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:HARCHUCK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:PATRICIA
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3823 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9041
Mailing Address - Country:US
Mailing Address - Phone:412-841-8891
Mailing Address - Fax:
Practice Address - Street 1:3823 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9041
Practice Address - Country:US
Practice Address - Phone:412-841-8891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011196L225100000X
FLPT31076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist