Provider Demographics
NPI:1093165037
Name:DEVARY, COLIN
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:DEVARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50468-1251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST SE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IA
Practice Address - Zip Code:50468-1251
Practice Address - Country:US
Practice Address - Phone:641-210-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013877225200000X
IA079738225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant