Provider Demographics
NPI:1275655532
Name:CONNAUGHTON, COLLEEN (MPT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:CONNAUGHTON
Suffix:
Gender:F
Credentials:MPT, DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:WESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT, DPT
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:47 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2324
Practice Address - Country:US
Practice Address - Phone:201-384-2525
Practice Address - Fax:201-384-2625
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01160500171W00000X, 225100000X
MD22009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor