Provider Demographics
NPI:1710277801
Name:ONKOTZ, CARLY MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MICHELLE
Last Name:ONKOTZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:ONKOTZ
Other - Last Name:WHEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:526 WESTERLY PKWY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5905
Mailing Address - Country:US
Mailing Address - Phone:814-996-1150
Mailing Address - Fax:
Practice Address - Street 1:526 WESTERLY PKWY
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5905
Practice Address - Country:US
Practice Address - Phone:814-996-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PAPT021194225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist