Provider Demographics
NPI:1568170561
Name:WAYCHOFF, CARLA COHEN
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:COHEN
Last Name:WAYCHOFF
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 1:778 BOBWHITE LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-2120
Mailing Address - Country:US
Mailing Address - Phone:267-250-3911
Mailing Address - Fax:
Practice Address - Street 1:778 BOBWHITE LN
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-2120
Practice Address - Country:US
Practice Address - Phone:267-250-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012274L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist