Provider Demographics
NPI:1871855825
Name:COLEGROVE, MICHAEL L (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:COLEGROVE
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 1:9101 ASHTON BROOK DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8467
Mailing Address - Country:US
Mailing Address - Phone:336-971-3000
Mailing Address - Fax:
Practice Address - Street 1:9101 ASHTON BROOK DR
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-8467
Practice Address - Country:US
Practice Address - Phone:336-971-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP46272251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP4627OtherPHYSICAL THERAPY