Provider Demographics
NPI:1053849828
Name:COLLADO, JOSE ISMEL (PT, DPT, LMT)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ISMEL
Last Name:COLLADO
Suffix:
Gender:
Credentials:PT, DPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WEDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1927
Mailing Address - Country:US
Mailing Address - Phone:917-515-0288
Mailing Address - Fax:
Practice Address - Street 1:250 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4158
Practice Address - Country:US
Practice Address - Phone:917-515-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007864225700000X
CT14775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist