Provider Demographics
NPI:1659312858
Name:KOLONGOWSKI, MARCIA (PT)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:KOLONGOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:4948 PENNELL RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-1867
Practice Address - Country:US
Practice Address - Phone:610-494-8730
Practice Address - Fax:610-494-9671
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001530225100000X
NJ40QA00877400225100000X
PAPT013157L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0879632OtherBCBS
PA102313867Medicaid
PA000000254533OtherAMERICHOICE
PA07759438Medicaid
0792818000OtherIBC
PA30068646OtherKEYSTONE MERCY
87639OtherHIGHMARK PABS
PA1659312858OtherBRAVO
P00692901OtherRAILROAD MEDICARE
PA057774VLZOtherMEDICARE
P00692901OtherRAILROAD MEDICARE
PA05774ULZMedicare PIN
PA0879632OtherBCBS