Provider Demographics
NPI:1144507559
Name:BURLEIGH, COLONETTE JANE (PT)
Entity type:Individual
Prefix:MS
First Name:COLONETTE
Middle Name:JANE
Last Name:BURLEIGH
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 1:135 CHAMPLAIN AVE.
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883-1313
Mailing Address - Country:US
Mailing Address - Phone:518-585-2202
Mailing Address - Fax:
Practice Address - Street 1:2758 MAIN STREET
Practice Address - Street 2:CROWN POINT CENTRAL SCHOOL
Practice Address - City:CROWN POINT
Practice Address - State:NY
Practice Address - Zip Code:12928-0035
Practice Address - Country:US
Practice Address - Phone:518-597-3285
Practice Address - Fax:518-597-4121
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001663-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy