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General NPI Number Information
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NPI Number | 1831704469
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Entity Type | Individual
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Provider Name | COLLEEN M BROUGH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 710 W 168TH ST STE 336
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City | NEW YORK
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State | NY
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Zip | 10032-3726
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Country | US
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Telephone | 917-538-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 39 DEVONSHIRE CT
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-1815
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Country | US
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Telephone |
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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 | 40QA02375400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 072269
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License Number State | NY
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