Provider Demographics
NPI:1568634277
Name:BRAUCH, COLLEEN M (DPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:BRAUCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MULDOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:16 PELHAM RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2826
Mailing Address - Country:US
Mailing Address - Phone:603-894-1111
Mailing Address - Fax:603-894-1113
Practice Address - Street 1:16 PELHAM RD STE 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2826
Practice Address - Country:US
Practice Address - Phone:603-894-1111
Practice Address - Fax:603-894-1113
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist