Provider Demographics
NPI:1417940859
Name:COLBERT, ISAAC SEAN (ATC)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:SEAN
Last Name:COLBERT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9825 MOYER RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2305
Mailing Address - Country:US
Mailing Address - Phone:301-253-1216
Mailing Address - Fax:
Practice Address - Street 1:NORTHWESTERN STATE UNIVERSITY
Practice Address - Street 2:ATHLETIC FIELDHOUSE
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71497-0001
Practice Address - Country:US
Practice Address - Phone:318-357-4035
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer