Provider Demographics
NPI:1437794518
Name:COLWELL, NATHANIEL LEWIS (DPT)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:LEWIS
Last Name:COLWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40767
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-0767
Mailing Address - Country:US
Mailing Address - Phone:904-376-3707
Mailing Address - Fax:
Practice Address - Street 1:12961 N MAIN ST STE 201&202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2769
Practice Address - Country:US
Practice Address - Phone:904-757-2474
Practice Address - Fax:904-757-5541
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist