Individual
DR. COLETTE TARA D'ALTILIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
2100 E SAMPLE RD, SUITE 203, LIGHTHOUSE POINT, FL 33064-7574
(954) 933-9033
(954) 934-0060
Mailing address
2100 E SAMPLE RD, SUITE 203, LIGHTHOUSE POINT, FL 33064-7596
(954) 933-9033
(954) 934-0060
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO 3030
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3405150-00
—
FL
Enumeration date
01/26/2006
Last updated
07/08/2011
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