Provider Demographics
NPI:1124364682
Name:SPARROW, COLLEEN JOHNSON (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOHNSON
Last Name:SPARROW
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9382
Mailing Address - Country:US
Mailing Address - Phone:757-470-1954
Mailing Address - Fax:
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-966-1424
Practice Address - Fax:919-966-0348
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11221282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ48574AMedicare UPIN