Provider Demographics
NPI:1225661093
Name:MILLEN, COLBY JASON (PTA)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:JASON
Last Name:MILLEN
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 1:14 RAMSGATE CT
Mailing Address - Street 2:
Mailing Address - City:ARBUTUS
Mailing Address - State:MD
Mailing Address - Zip Code:21227-3847
Mailing Address - Country:US
Mailing Address - Phone:443-740-1397
Mailing Address - Fax:
Practice Address - Street 1:14 RAMSGATE CT
Practice Address - Street 2:
Practice Address - City:ARBUTUS
Practice Address - State:MD
Practice Address - Zip Code:21227-3847
Practice Address - Country:US
Practice Address - Phone:443-740-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3857225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant