Basic Information
| Provider Information | |||||||||
| NPI: | 1528375763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLL | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3228 STATE ROUTE 27 | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088241524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322970032 | ||||||||
| FaxNumber: | 7322970558 | ||||||||
| Practice Location | |||||||||
| Address1: | 3228 STATE ROUTE 27 | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | KENDALL PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088241524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322970032 | ||||||||
| FaxNumber: | 7322970558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 09/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01361700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.