Healthcare Provider Details

I. General information

NPI: 1316487911
Provider Name (Legal Business Name): ANDREW COLLENTRO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 ANDREW AVE STE 201
WAYLAND MA
01778-3026
US

IV. Provider business mailing address

4 RICHMOND SQ STE 201
PROVIDENCE RI
02906-5117
US

V. Phone/Fax

Practice location:
  • Phone: 508-358-3410
  • Fax: 844-912-8609
Mailing address:
  • Phone: 401-433-4172
  • Fax: 401-433-0612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1276095
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL21203
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: