Provider Demographics
NPI:1053627430
Name:WILLIAMS, COLLEEN BREEN (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:BREEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 SALLY PIPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1116
Mailing Address - Country:US
Mailing Address - Phone:607-727-7329
Mailing Address - Fax:607-785-2632
Practice Address - Street 1:3636 SALLY PIPER RD
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1116
Practice Address - Country:US
Practice Address - Phone:607-727-7329
Practice Address - Fax:607-785-2632
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009392-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist