Provider Demographics
NPI:1386255313
Name:MALITSKY, COLLEEN COSKER (DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:COSKER
Last Name:MALITSKY
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 1:62 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2625
Mailing Address - Country:US
Mailing Address - Phone:860-416-2397
Mailing Address - Fax:
Practice Address - Street 1:893 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2293
Practice Address - Country:US
Practice Address - Phone:860-289-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist