Provider Demographics
NPI:1609440361
Name:JOHNCOLA, MICHAEL GREGORY JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREGORY
Last Name:JOHNCOLA
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-267-9400
Mailing Address - Fax:856-270-2786
Practice Address - Street 1:570 EGG HARBOR RD STE C2
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:609-267-9400
Practice Address - Fax:856-270-2786
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD225100000X
PAPT029668225100000X
NJ40QA02065600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist