Provider Demographics
NPI:1114565983
Name:COLABELLA, ANTHONY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:COLABELLA
Suffix:
Gender:M
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 1:65 HOPE ST APT 24B
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-2625
Mailing Address - Country:US
Mailing Address - Phone:203-641-6655
Mailing Address - Fax:
Practice Address - Street 1:703 W BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3320
Practice Address - Country:US
Practice Address - Phone:914-597-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11939225100000X
NY043987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist