Provider Demographics
NPI:1932594819
Name:COLABRARO, JUSTINE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:COLABRARO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3701
Mailing Address - Country:US
Mailing Address - Phone:862-812-0346
Mailing Address - Fax:
Practice Address - Street 1:64 BENTWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-3701
Practice Address - Country:US
Practice Address - Phone:862-812-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist