Provider Demographics
NPI:1548278575
Name:GRUICI, COLLEEN M (MPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:GRUICI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:BIGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:500 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-334-4100
Practice Address - Fax:856-334-4015
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00901400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121863S2KMedicare PIN