Provider Demographics
NPI:1629190996
Name:OGREAN, MARYELLEN HARVEY (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:HARVEY
Last Name:OGREAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 SAN FELICE PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5947
Mailing Address - Country:US
Mailing Address - Phone:719-540-3696
Mailing Address - Fax:
Practice Address - Street 1:6165 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3441
Practice Address - Country:US
Practice Address - Phone:719-264-8524
Practice Address - Fax:719-264-8526
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist