Provider Demographics
NPI:1538968961
Name:GROMBALA, COLLEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GROMBALA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E 14 MILE RD APT 7
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5103
Mailing Address - Country:US
Mailing Address - Phone:248-230-0048
Mailing Address - Fax:
Practice Address - Street 1:6785 23 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4414
Practice Address - Country:US
Practice Address - Phone:586-788-7107
Practice Address - Fax:586-371-2037
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501303695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist