Provider Demographics
NPI:1457784100
Name:HOWARD, COLLEEN MARISA (DPT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARISA
Last Name:HOWARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARISA
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 BUTTRICK CT
Mailing Address - Street 2:#204
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1920
Mailing Address - Country:US
Mailing Address - Phone:570-721-1152
Mailing Address - Fax:
Practice Address - Street 1:1401 PULASKI HWY STE F
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1398
Practice Address - Country:US
Practice Address - Phone:443-372-5300
Practice Address - Fax:443-372-5810
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist