Provider Demographics
NPI:1043550379
Name:COLON, LUZ EVELYN (OT)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:EVELYN
Last Name:COLON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 MC CLUNG DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-7205
Mailing Address - Country:US
Mailing Address - Phone:727-376-2540
Mailing Address - Fax:
Practice Address - Street 1:5006 TROUBLE CREEK RD
Practice Address - Street 2:STE 233
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4939
Practice Address - Country:US
Practice Address - Phone:727-376-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 2787225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist