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General NPI Number Information
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NPI Number | 1538968961
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Entity Type | Individual
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Provider Name | COLLEEN GROMBALA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 6785 23 MILE RD
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48316-4414
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Country | US
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Telephone | 586-788-7107
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Fax | 586-371-2037
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Provider Business Mailing Address
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Address Line | 355 E 14 MILE RD APT 7
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5103
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Country | US
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Telephone | 248-230-0048
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501303695
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License Number State | MI
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