Provider Demographics
NPI:1407415425
Name:COLLETTE, KATHLEEN MARY (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:COLLETTE
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 1:60 COOKS BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:ME
Mailing Address - Zip Code:04005-7025
Mailing Address - Country:US
Mailing Address - Phone:207-841-9572
Mailing Address - Fax:
Practice Address - Street 1:13 JULY ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-1909
Practice Address - Country:US
Practice Address - Phone:207-490-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist