Provider Demographics
NPI:1689030728
Name:MARTINO, COLLEEN MARIE (BS/MSPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:BS/MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MELROY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1658
Mailing Address - Country:US
Mailing Address - Phone:716-819-5036
Mailing Address - Fax:716-819-5099
Practice Address - Street 1:55 MELROY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14218-1658
Practice Address - Country:US
Practice Address - Phone:716-819-5036
Practice Address - Fax:716-819-5099
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014257-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist