Provider Demographics
NPI:1053304485
Name:COLLURA, RYAN H (LAT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:H
Last Name:COLLURA
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WINCHESTER DR
Mailing Address - Street 2:608
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6096
Mailing Address - Country:US
Mailing Address - Phone:337-988-6602
Mailing Address - Fax:337-988-6602
Practice Address - Street 1:128 E BUTCHER SWITCH RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3528
Practice Address - Country:US
Practice Address - Phone:337-233-8080
Practice Address - Fax:337-237-1623
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.J003402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer