1649319971 NPI number — MRS. COLLEEN M. MROWKA P.T., D.P.T.

Table of content: MIRANDA LYNN COOK (NPI 1356054092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649319971 NPI number — MRS. COLLEEN M. MROWKA P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MROWKA
Provider First Name:
COLLEEN
Provider Middle Name:
M.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAROT
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649319971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 WEST MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESHIRE
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-250-0334
Provider Business Mailing Address Fax Number:
203-250-0336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESHIRE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-250-0334
Provider Business Practice Location Address Fax Number:
203-250-0336
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  003788 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650007915 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0106401 . This is a "ACS ORTHONET" identifier . This identifiers is of the category "OTHER".
  • Identifier: OV1701 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080003788CT07 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC1107 . This is a "OXFORD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83826 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061373509 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061373509 . This is a "HMC PPO" identifier . This identifiers is of the category "OTHER".




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