Provider Demographics
NPI:1962473850
Name:KUSMIERSKI, COLLEEN J (PT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:J
Last Name:KUSMIERSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 CORBIN AVE
Mailing Address - Street 2:JEROME HOME
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1243
Mailing Address - Country:US
Mailing Address - Phone:860-229-3707
Mailing Address - Fax:860-832-9310
Practice Address - Street 1:975 CORBIN AVE
Practice Address - Street 2:JEROME HOME
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1243
Practice Address - Country:US
Practice Address - Phone:860-229-3707
Practice Address - Fax:860-832-9310
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist