Provider Demographics
NPI:1649319971
Name:MROWKA, COLLEEN M (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:MROWKA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:MAROT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:423 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410
Mailing Address - Country:US
Mailing Address - Phone:203-250-0334
Mailing Address - Fax:203-250-0336
Practice Address - Street 1:423 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410
Practice Address - Country:US
Practice Address - Phone:203-250-0334
Practice Address - Fax:203-250-0336
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
650007915OtherMEDICARE RAILROAD
0106401OtherACS ORTHONET
OV1701OtherHEALTHNET
080003788CT07OtherANTHEM BCBS
ANC1107OtherOXFORD HEALTH PLAN
83826OtherAETNA
061373509OtherUNITED HEALTHCARE
061373509OtherHMC PPO
650000247Medicare ID - Type Unspecified