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General NPI Number Information
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NPI Number | 1558426098
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Entity Type | Organization
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Legal Business Name | COLONIAL PHYSICAL THERAPY
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1702 STATE ROUTE 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-1832
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Country | US
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Telephone | 732-615-9622
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Fax | 732-615-9624
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Provider Business Mailing Address
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Address Line | 1702 STATE ROUTE 35
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-1832
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Country | US
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Telephone | 732-615-9622
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Fax | 732-615-9624
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. RALPH DESIDERIO
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Credential | M.S.P.T.
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Telephone | 732-615-9622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA00884200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA00806100
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License Number State | NJ
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