Provider Demographics
NPI:1548399389
Name:MONTEMARANO, COLLEEN D (PT,MS,DPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:D
Last Name:MONTEMARANO
Suffix:
Gender:F
Credentials:PT,MS,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ARTHUR WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-2517
Mailing Address - Country:US
Mailing Address - Phone:781-272-8518
Mailing Address - Fax:
Practice Address - Street 1:10 GILL ST # J
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1721
Practice Address - Country:US
Practice Address - Phone:781-932-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159342251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69119Medicare ID - Type UnspecifiedMEDICAR B PROVIDER NUMBER