Individual
MR. BRYAN JOSEPH O'HALLORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T. SCS, OCS
Contact information
Practice address
57 W EAGLE RD, HAVERTOWN, PA 19083-2234
(610) 789-9887
(610) 789-9883
Mailing address
316 VALLEY RD, HAVERTOWN, PA 19083-5434
(610) 789-1599
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-002907-E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0660220000
KEYSTONE PIN
PA
01
—
0959942
AETNA HMO PROVIDER#
PA
01
—
38720
BC/BS PIN
PA
01
—
5245562
AETNA TRADITIONAL PROV. #
PA
01
—
650015206
MEDICARE RAILROAD PIN
PA
01
—
689220
UNITED HEALTHCARE PROV. #
PA
Enumeration date
04/12/2006
Last updated
06/30/2010
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