Provider Demographics
NPI:1194012690
Name:SCORDATO, COLLEEN (DPT, MDT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:SCORDATO
Suffix:
Gender:F
Credentials:DPT, MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4909
Mailing Address - Country:US
Mailing Address - Phone:407-691-7687
Mailing Address - Fax:407-691-7697
Practice Address - Street 1:1341 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4909
Practice Address - Country:US
Practice Address - Phone:407-691-7687
Practice Address - Fax:407-691-7697
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist