1477602688 NPI number — MISS LINDSAY MICHELLE COLLEY PT, MSPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477602688 NPI number — MISS LINDSAY MICHELLE COLLEY PT, MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLEY
Provider First Name:
LINDSAY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT, MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COILEY
Provider Other First Name:
LINDSAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477602688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2555 PHILLIPS FIELD ROAD SUITE 202
Provider Second Line Business Mailing Address:
WILLOW PHYSICAL THERAPY
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99709-3933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-456-5990
Provider Business Mailing Address Fax Number:
907-456-7418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 TOWN WEST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03264-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-744-0275
Provider Business Practice Location Address Fax Number:
603-744-9378
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  3160 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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