Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | 40QA01331000 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40QA01331000 | NJ |
NPI | 1104269604 |
---|---|
Provider Name | Jennifer M Colonna |
First Address | Manchester, NJ 08759-5806 |
Second Address | Manchester, NJ 08759-5806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |