Provider Demographics
NPI:1104269604
Name:COLONNA, JENNIFER M (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:COLONNA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5806
Mailing Address - Country:US
Mailing Address - Phone:732-408-1800
Mailing Address - Fax:732-408-0704
Practice Address - Street 1:1037 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-5806
Practice Address - Country:US
Practice Address - Phone:732-408-1800
Practice Address - Fax:732-408-0704
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA013310002251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics