Healthcare Provider Details

I. General information

NPI: 1144507559
Provider Name (Legal Business Name): COLONETTE JANE BURLEIGH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2758 MAIN STREET CROWN POINT CENTRAL SCHOOL
CROWN POINT NY
12928-0035
US

IV. Provider business mailing address

135 CHAMPLAIN AVE.
TICONDEROGA NY
12883-1313
US

V. Phone/Fax

Practice location:
  • Phone: 518-597-3285
  • Fax: 518-597-4121
Mailing address:
  • Phone: 518-585-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number001663-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: