Provider Demographics
NPI:1689764904
Name:COLONNA, PAUL ANTHONY (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ANTHONY
Last Name:COLONNA
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1158 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4205
Mailing Address - Country:US
Mailing Address - Phone:516-868-8880
Mailing Address - Fax:516-868-0685
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:305
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-354-9250
Practice Address - Fax:516-358-5359
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2019-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY8012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ61762Medicare ID - Type Unspecified