Provider Demographics
NPI:1487960837
Name:SUDOL, COLLEEN W (PT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:W
Last Name:SUDOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1002
Mailing Address - Country:US
Mailing Address - Phone:315-652-4323
Mailing Address - Fax:315-622-1110
Practice Address - Street 1:8390 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1002
Practice Address - Country:US
Practice Address - Phone:315-652-4323
Practice Address - Fax:315-622-1110
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0330001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist