Provider Demographics
NPI:1477007870
Name:DAVIS, COLLEEN (DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:GIANSIRACUSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:73 PRINCETON STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863
Mailing Address - Country:US
Mailing Address - Phone:978-710-7204
Mailing Address - Fax:978-710-5764
Practice Address - Street 1:73 PRINCETON STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863
Practice Address - Country:US
Practice Address - Phone:978-710-7204
Practice Address - Fax:978-710-5764
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist