Colleen R Wallace, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4692 Issued in NH

Practice address

20 Lake St
Bristol, NH 03222-4009

Phone

(603) 393-0135

NPI assigned

Aug 27, 2020

Last updated

Nov 27, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vital Strength Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Bristol, NH
  • NPI 1306662994
  NPD Authorized official
• Progressive Therapy Services LLC

  • Physical Therapy Clinic/Center
  • Bow, NH
  • NPI 1386933430
  NPD
• Coppola Physical Therapy Farmington LLC

  • Physical Therapist
  • Farmington, NH
  • NPI 1508142159
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1457964678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "BRISTOL",
            "state": "NH",
            "postal_code": "032220430",
            "telephone_number": "603-393-0135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 LAKE ST",
            "city": "BRISTOL",
            "state": "NH",
            "postal_code": "032224009",
            "telephone_number": "603-393-0135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COLLEEN",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-27",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "4692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Quint Therriault
• Town of Bristol (Town of Bristol Fire Department)
• Sarah A Vaida, APRN
• Janice E Vaughn, APRN
• Vital Strength Physical Therapy LLC
• Thomas Clifford White, RPH
• Kathleen Wichland, PSYD
• Tina M Winters, FNP-BC

• Physical Therapist in Bristol, NH
• Providers in Bristol, NH by specialty
• Physical Therapist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.