Provider Demographics
NPI:1508496472
Name:D'ANNUNZIO, COLLEEN A (RYT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:D'ANNUNZIO
Suffix:
Gender:F
Credentials:RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 DOC BROWN RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-8081
Mailing Address - Country:US
Mailing Address - Phone:910-527-8512
Mailing Address - Fax:
Practice Address - Street 1:406 W DONALDSON AVE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2618
Practice Address - Country:US
Practice Address - Phone:910-690-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer