Provider Demographics
NPI:1376690693
Name:COLVIN, BRIAN HUSTON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HUSTON
Last Name:COLVIN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 PORT SHELDON ST STE A
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9297
Mailing Address - Country:US
Mailing Address - Phone:616-662-0990
Mailing Address - Fax:616-662-0992
Practice Address - Street 1:3152 PORT SHELDON ST STE A
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-9297
Practice Address - Country:US
Practice Address - Phone:616-662-0990
Practice Address - Fax:616-662-0992
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist