Provider Demographics
NPI:1306174867
Name:WARN, COLLEEN FUNG (PT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:FUNG
Last Name:WARN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:FUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:98 CRAIG ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8729
Mailing Address - Country:US
Mailing Address - Phone:732-625-7700
Mailing Address - Fax:732-625-7721
Practice Address - Street 1:98 CRAIG ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8729
Practice Address - Country:US
Practice Address - Phone:732-625-7700
Practice Address - Fax:732-625-7721
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01056300225100000X
NY018167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist