Provider Demographics
NPI:1629963442
Name:BOLES, COLLEEN LYNN (LMT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LYNN
Last Name:BOLES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 RIDGECREST TER APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5241
Mailing Address - Country:US
Mailing Address - Phone:857-347-6757
Mailing Address - Fax:
Practice Address - Street 1:25 SCHOOL ST STE B2
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6665
Practice Address - Country:US
Practice Address - Phone:617-689-0440
Practice Address - Fax:617-689-0420
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist