Provider Demographics
NPI:1639851181
Name:LANCE, COLLEEN MADDY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:MADDY
Last Name:LANCE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MICHELLE
Other - Last Name:MADDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD # PMR117
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:352-379-4127
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD # PMR117
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-379-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist