Provider Demographics
NPI:1972381218
Name:ULITCHNEY, COLLEEN KIMBERLY (MSPT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KIMBERLY
Last Name:ULITCHNEY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-7774
Mailing Address - Country:US
Mailing Address - Phone:570-709-5119
Mailing Address - Fax:
Practice Address - Street 1:24 W LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-7774
Practice Address - Country:US
Practice Address - Phone:570-709-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0163162251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics