Provider Demographics
NPI:1467466821
Name:ELLIOT, COLIN JC (MCSP, RPT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:JC
Last Name:ELLIOT
Suffix:
Gender:M
Credentials:MCSP, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD
Mailing Address - Street 2:STE 202
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2689
Mailing Address - Country:US
Mailing Address - Phone:540-341-1735
Mailing Address - Fax:540-341-8610
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:STE 202
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2689
Practice Address - Country:US
Practice Address - Phone:540-341-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist