Healthcare Provider Details

I. General information

NPI: 1841246147
Provider Name (Legal Business Name): COLLEEN A. RUSHMORE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BRIDGEBORO RD
DELRAN NJ
08075-9700
US

IV. Provider business mailing address

160 RAMBLEWOOD RD
MOORESTOWN NJ
08057-2628
US

V. Phone/Fax

Practice location:
  • Phone: 856-764-0494
  • Fax:
Mailing address:
  • Phone: 856-778-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00360000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005375-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: