Provider Demographics
NPI:1508135856
Name:COLONGHI, JANET S (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:COLONGHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LEE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:595 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1156
Mailing Address - Country:US
Mailing Address - Phone:860-759-2011
Mailing Address - Fax:860-342-4104
Practice Address - Street 1:595 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1156
Practice Address - Country:US
Practice Address - Phone:860-759-2011
Practice Address - Fax:860-342-4104
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist