Provider Demographics
NPI:1023451226
Name:BAQUERO, COLEEN (PT, MSPT)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WYLIE TER
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1436
Mailing Address - Country:US
Mailing Address - Phone:732-547-1968
Mailing Address - Fax:
Practice Address - Street 1:19 WYLIE TER
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1436
Practice Address - Country:US
Practice Address - Phone:732-547-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01106700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist