Provider Demographics
NPI:1053502682
Name:BARTON, COLLEEN NICOLE (PT DPT)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:NICOLE
Last Name:BARTON
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 MENDOLEINE RD
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9406
Mailing Address - Country:US
Mailing Address - Phone:585-781-4306
Mailing Address - Fax:
Practice Address - Street 1:9929 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4458
Practice Address - Country:US
Practice Address - Phone:727-789-5992
Practice Address - Fax:727-787-5975
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist