Provider Demographics
NPI:1700927274
Name:RONKOWSKI, COLLEEN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:RONKOWSKI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CANDLELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1355
Mailing Address - Country:US
Mailing Address - Phone:856-769-4462
Mailing Address - Fax:856-455-9791
Practice Address - Street 1:70 MANEIM AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-455-9700
Practice Address - Fax:856-455-9791
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00931600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-6704Medicare ID - Type Unspecified