Provider Demographics
NPI:1679510085
Name:COOLACK, JOANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:
Last Name:COOLACK
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 1:57 CONEY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1049
Mailing Address - Country:US
Mailing Address - Phone:973-200-0832
Mailing Address - Fax:
Practice Address - Street 1:362 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-3415
Practice Address - Country:US
Practice Address - Phone:973-478-3006
Practice Address - Fax:973-680-0307
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00997400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist