Provider Demographics
NPI:1821059254
Name:KEARNEY, COLLEEN MARY BARRY (MS PT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARY BARRY
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1122
Mailing Address - Country:US
Mailing Address - Phone:917-873-4134
Mailing Address - Fax:
Practice Address - Street 1:42 RIDGE LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1122
Practice Address - Country:US
Practice Address - Phone:917-873-4134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07B51Medicare ID - Type Unspecified