Provider Demographics
NPI:1235100488
Name:COLWILL, JENNIFER ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:COLWILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 FEURA BUSH RD & 9W
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-2983
Mailing Address - Country:US
Mailing Address - Phone:518-436-3954
Mailing Address - Fax:518-436-4257
Practice Address - Street 1:365 FEURA BUSH RD & 9W
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2983
Practice Address - Country:US
Practice Address - Phone:518-436-3954
Practice Address - Fax:518-436-4257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0214951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7950316OtherPPO POS
363485OtherMVP
4651OtherCDPHP GROUP
QM0182OtherEMPIRE BCBS CATSKILL
000499688002OtherBSNENY CATSKILL CROSSLINK
QM018OtherEMPIRE BCBS BETHLEHEM
000499688001OtherBSNENY BETHLEHEM CROSSLIN
10058674OtherCDPHP
2720216OtherHMO GLENMONT
00996882OtherBS NENY CATSKILL BILLING
2720219OtherHMO CATSKILL