Provider Demographics
NPI:1932509445
Name:FIELDS, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1111
Mailing Address - Country:US
Mailing Address - Phone:617-536-1161
Mailing Address - Fax:617-536-1165
Practice Address - Street 1:425 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2063
Practice Address - Country:US
Practice Address - Phone:617-244-1990
Practice Address - Fax:617-244-1811
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist