Provider Demographics
NPI:1689055857
Name:COGLIANESE, DEBRA ELAINE (PT, DPT, OCS, ATC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ELAINE
Last Name:COGLIANESE
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 WAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-2444
Mailing Address - Country:US
Mailing Address - Phone:610-649-3756
Mailing Address - Fax:
Practice Address - Street 1:608 WAYFIELD RD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-2444
Practice Address - Country:US
Practice Address - Phone:610-649-3756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-14
Last Update Date:2015-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0188732251X0800X
MA97212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic