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General NPI Number Information
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NPI Number | 1982185286
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Entity Type | Individual
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Provider Name | MARIANETTE COL PT
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Gender | Female
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 210 NORTH AVE E
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City | CRANFORD
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State | NJ
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Zip | 07016-2491
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Country | US
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Telephone | 908-276-0237
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 EDMUND TER
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City | UNION
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State | NJ
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Zip | 07083-4006
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Country | US
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Telephone | 480-395-5709
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA01799900
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License Number State | NJ
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