Provider Demographics
NPI:1679453971
Name:LISCOMB, COLIN
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:LISCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 DEER MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-1537
Mailing Address - Country:US
Mailing Address - Phone:860-992-5868
Mailing Address - Fax:
Practice Address - Street 1:57 DEER MEADOW LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-1537
Practice Address - Country:US
Practice Address - Phone:860-992-5868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty