Provider Demographics
NPI:1275703621
Name:HANDLE, COLLEEN MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIE
Last Name:HANDLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4028
Mailing Address - Country:US
Mailing Address - Phone:417-597-5333
Mailing Address - Fax:
Practice Address - Street 1:208 S OAK ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4028
Practice Address - Country:US
Practice Address - Phone:417-597-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004027777225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant