Provider Demographics
NPI:1093845463
Name:COLUMB, PAUL (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:COLUMB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 MOLALLA AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3753
Mailing Address - Country:US
Mailing Address - Phone:907-747-5861
Mailing Address - Fax:907-747-5415
Practice Address - Street 1:700 KATLIAN ST STE E
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-7359
Practice Address - Country:US
Practice Address - Phone:907-747-5861
Practice Address - Fax:907-747-5415
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT1135Medicaid
AKP39505Medicare UPIN
AKPT1135Medicaid