Individual provider Active NPI

Colleen M Dibernardo, M.S.P.T.

  • Physical Therapist
  • West Chester, PA
National Provider Identifier
1043412380
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT017842 Issued in PA
Practice address
915 Old Fern Hill Rd
Suite 4
West Chester, PA 19380-4269
Phone
(610) 738-2480
Fax
(610) 738-2485
NPI assigned
May 31, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT017842 PA Primary

Addresses

Primary practice location

915 Old Fern Hill Rd
Suite 4
West Chester, PA 19380-4269

Mailing address

1312 Morstein Rd
West Chester, PA 19380-3608
Phone (610) 696-3694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230404000794 NY Practitioner - Physical Therapist in Private Practice 1355716408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Onondaga Physical Therapy, LLCGroup PAC ID 8325039365, 25 clinicians

Practice addresses (Care Compare)

11867 W Main St
Wolcott, NY 14590-1025
Phone (315) 635-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
20004NYMDPsychologist
PT017842PAMDPhysical Therapist
020004NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Onondaga Physical Therapy, LLC Physical Therapist Current Accepting new patients
Onondaga Physical Therapy Physical Therapist CurrentSince Mar 1, 2023 Accepting new patients
Onondaga Physical Therapy, LLC Physical Therapist CurrentSince Mar 1, 2023 Accepting new patients
Riccardi & Burton Physical Therapy P.C. Physical Therapist Past Accepting new patients
Onondaga Physical Therapy, LLC Physical Therapist Past Accepting new patients

Locations

19 E Genesee St
Ste 103
Baldwinsville, NY 13027

8390 Oswego Rd
Liverpool, NY 13090
Phone (315) 652-4323

11867 W Main St
Wolcott, NY 14590
Phone (315) 877-9747

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043412380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 MORSTEIN RD",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193803608",
            "telephone_number": "610-696-3694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 OLD FERN HILL RD",
            "address_2": "SUITE 4",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193804269",
            "telephone_number": "610-738-2480",
            "fax_number": "610-738-2485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBERNARDO",
        "first_name": "COLLEEN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "M.S.P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT017842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.