Healthcare Provider Details

I. General information

NPI: 1003947987
Provider Name (Legal Business Name): COLYNN ANNE FURGASON MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLYNN ANNE LABERGE MSPT

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 CABIN RD
ABERDEEN MD
21001-1301
US

IV. Provider business mailing address

PO BOX 179
FOREST HILL MD
21050-0179
US

V. Phone/Fax

Practice location:
  • Phone: 410-262-0259
  • Fax:
Mailing address:
  • Phone: 410-838-9600
  • Fax: 410-838-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20796
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number20796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: