Provider Demographics
NPI:1891758694
Name:BACKUS, COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BACKUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:GLEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 WELLS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1200
Mailing Address - Country:US
Mailing Address - Phone:518-587-0637
Mailing Address - Fax:518-587-2515
Practice Address - Street 1:7 WELLS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1200
Practice Address - Country:US
Practice Address - Phone:518-587-0637
Practice Address - Fax:518-587-2515
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ55081OtherEMPIRE BLUE CROSS
NY10000074OtherCDPHP
NY2289411OtherAETNA HMO
NY5683569OtherAETNA PPO
NY43115OtherMVP HEALTH PLAN
NY000492521001OtherBLUE SHIELD OF NORTHEASTE
NY43115OtherMVP HEALTH PLAN
NY5683569OtherAETNA PPO