Provider Demographics
NPI:1457746273
Name:WRIGHT, COLLEEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-9512
Mailing Address - Country:US
Mailing Address - Phone:609-367-5319
Mailing Address - Fax:
Practice Address - Street 1:433 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-9512
Practice Address - Country:US
Practice Address - Phone:609-367-5319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00209100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant