Healthcare Provider Details

I. General information

NPI: 1518051622
Provider Name (Legal Business Name): COLLEEN MARIE ALTON PHYSICAL THERAPIST A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN MARIE O NEIL PHYSICAL THERAPIST A

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WHIPPLE LANE
ROCHESTER NY
14622
US

IV. Provider business mailing address

3585 ROOSEVELT HWY
HAMLIN NY
14464
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-3070
  • Fax: 585-336-5014
Mailing address:
  • Phone: 585-964-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0050261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: