Provider Demographics
NPI:1619157328
Name:COLLARINI, GENO (PT)
Entity Type:Individual
Prefix:
First Name:GENO
Middle Name:
Last Name:COLLARINI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1356
Mailing Address - Country:US
Mailing Address - Phone:570-346-1570
Mailing Address - Fax:570-346-1708
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1549
Practice Address - Country:US
Practice Address - Phone:570-346-1570
Practice Address - Fax:570-346-1708
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist