Provider Demographics
NPI:1295799914
Name:O'HALLORAN, BRYAN JOSEPH (PT SCS, OCS)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:JOSEPH
Last Name:O'HALLORAN
Suffix:
Gender:M
Credentials:PT SCS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5434
Mailing Address - Country:US
Mailing Address - Phone:610-789-1599
Mailing Address - Fax:
Practice Address - Street 1:57 W EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2234
Practice Address - Country:US
Practice Address - Phone:610-789-9887
Practice Address - Fax:610-789-9883
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-002907-E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA38720OtherBC/BS PIN
PA689220OtherUNITED HEALTHCARE PROV. #
PA650015206OtherMEDICARE RAILROAD PIN
PA0660220000OtherKEYSTONE PIN
PA0959942OtherAETNA HMO PROVIDER#
PA0660220000OtherPERSONALCHOICE PROVIDER #
PA5245562OtherAETNA TRADITIONAL PROV. #
PA38720OtherBC/BS PIN