Provider Demographics
NPI:1689230526
Name:GRIFFITH, COLETTE (LMT)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5629
Mailing Address - Country:US
Mailing Address - Phone:315-793-9354
Mailing Address - Fax:315-724-2182
Practice Address - Street 1:2108 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5629
Practice Address - Country:US
Practice Address - Phone:315-793-9354
Practice Address - Fax:315-724-2182
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017130-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist