Provider Demographics
NPI:1477880805
Name:SCHANK, COLLEEN MARY (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:SCHANK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARY
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:273 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-6918
Mailing Address - Country:US
Mailing Address - Phone:207-233-4123
Mailing Address - Fax:
Practice Address - Street 1:75 US ROUTE 1 BYP
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1784
Practice Address - Country:US
Practice Address - Phone:207-475-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2586225100000X
NH3183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist