Provider Demographics
NPI:1821344102
Name:COLELLA, JUDITHANN (PTA)
Entity Type:Individual
Prefix:
First Name:JUDITHANN
Middle Name:
Last Name:COLELLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9997 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-4987
Mailing Address - Country:US
Mailing Address - Phone:614-214-4960
Mailing Address - Fax:
Practice Address - Street 1:19859 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-5345
Practice Address - Country:US
Practice Address - Phone:440-439-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA.05005225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant