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General NPI Number Information
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NPI Number | 1699184861
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Entity Type | Individual
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Provider Name | JACLYN COLLENTRO PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/20/2020
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Provider Practice Location Address
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Address Line | 1123 CENTRAL ST
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City | LEOMINSTER
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State | MA
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Zip | 01453-4960
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Country | US
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Telephone | 617-536-1161
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Fax |
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Provider Business Mailing Address
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Address Line | 5 PEARL ST
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City | SOUTHBOROUGH
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State | MA
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Zip | 01772-1923
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Country | US
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Telephone | 203-520-4101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1248080
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23426
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License Number State | MA
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