Basic Information
| Provider Information | |||||||||
| NPI: | 1659312858 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLONGOWSKI | ||||||||
| FirstName: | MARCIA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 4948 PENNELL RD | ||||||||
| Address2: | |||||||||
| City: | ASTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190141867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104948730 | ||||||||
| FaxNumber: | 6104949671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 06/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J10001530 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 40QA00877400 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT013157L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0879632 | 01 | PA | BCBS | OTHER | 102313867 | 05 | PA | MEDICAID | 000000254533 | 01 | PA | AMERICHOICE | OTHER | 07759438 | 05 | PA | MEDICAID | 0792818000 | 01 | IBC | OTHER | 30068646 | 01 | PA | KEYSTONE MERCY | OTHER | 87639 | 01 | HIGHMARK PABS | OTHER | 1659312858 | 01 | PA | BRAVO | OTHER | P00692901 | 01 | RAILROAD MEDICARE | OTHER | 057774VLZ | 01 | PA | MEDICARE | OTHER |