Provider Demographics
NPI:1326400367
Name:MCNALLY, COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MCNALLY
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 1:2773 COUNTY ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:HANNACROIX
Mailing Address - State:NY
Mailing Address - Zip Code:12087-3007
Mailing Address - Country:US
Mailing Address - Phone:518-852-8593
Mailing Address - Fax:
Practice Address - Street 1:11831 9W
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192-3605
Practice Address - Country:US
Practice Address - Phone:518-731-1157
Practice Address - Fax:518-731-1158
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist