Provider Demographics
NPI:1528375763
Name:COLL, SEAN JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:JOSEPH
Last Name:COLL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 STATE ROUTE 27
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1524
Mailing Address - Country:US
Mailing Address - Phone:732-297-0032
Mailing Address - Fax:732-297-0558
Practice Address - Street 1:3228 STATE ROUTE 27
Practice Address - Street 2:SUITE 2A
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1524
Practice Address - Country:US
Practice Address - Phone:732-297-0032
Practice Address - Fax:732-297-0558
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01361700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist