Provider Demographics
NPI:1407280951
Name:O'SHEA, COLLEEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:O'SHEA
Suffix:
Gender:F
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 1:15 CROYDEN RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4606
Mailing Address - Country:US
Mailing Address - Phone:516-526-1628
Mailing Address - Fax:
Practice Address - Street 1:15 CROYDEN RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4606
Practice Address - Country:US
Practice Address - Phone:516-526-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist