Provider Demographics
NPI:1437655180
Name:COOMBS, COLLEEN (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COOMBS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 SABAL BEND DR NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-5108
Mailing Address - Country:US
Mailing Address - Phone:937-603-7384
Mailing Address - Fax:937-603-7384
Practice Address - Street 1:13895 HWY 27
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-2549
Practice Address - Country:US
Practice Address - Phone:937-603-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL50492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer