Provider Demographics
NPI:1114624046
Name:ENGEL, COLTON DAVID (PTA)
Entity Type:Individual
Prefix:MR
First Name:COLTON
Middle Name:DAVID
Last Name:ENGEL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 HACKBERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUMPHREY
Mailing Address - State:NE
Mailing Address - Zip Code:68642-5400
Mailing Address - Country:US
Mailing Address - Phone:402-920-1471
Mailing Address - Fax:
Practice Address - Street 1:2500 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4225
Practice Address - Country:US
Practice Address - Phone:605-348-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2044225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant