Provider Demographics
NPI:1154440865
Name:COLOMBO, MARY LESLIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LESLIE
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 ROCKY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-6127
Mailing Address - Country:US
Mailing Address - Phone:978-474-0983
Mailing Address - Fax:
Practice Address - Street 1:450 LOWELL ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5305
Practice Address - Country:US
Practice Address - Phone:978-475-4056
Practice Address - Fax:978-475-4046
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5455225100000X
NH3197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist