Provider Demographics
NPI:1467604876
Name:COLASUONO, DEIRDRE DE VERE (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:DE VERE
Last Name:COLASUONO
Suffix:
Gender:F
Credentials:PT, DPT, MS, ATC
Other - Prefix:DR
Other - First Name:DEIRDRE
Other - Middle Name:DE VERE
Other - Last Name:REGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 EAGLE ROCK AVENUE
Practice Address - Street 2:EAST HANOVER
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936
Practice Address - Country:US
Practice Address - Phone:973-887-9000
Practice Address - Fax:973-887-3654
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01283800225100000X
NJ25MT001410002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer