Basic Information
| Provider Information | |||||||||
| NPI: | 1588903579 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLASUONNO | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 635 BELLE TERRE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314740008 | ||||||||
| FaxNumber: | 6314740224 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 CONOWINGO RD STE C | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210141809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104202257 | ||||||||
| FaxNumber: | 4104202267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2013 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 036075 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 26896 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.