Provider Demographics
NPI:1497308423
Name:COLQUITT, JOSE
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:COLQUITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 MCARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6924
Mailing Address - Country:US
Mailing Address - Phone:910-868-2002
Mailing Address - Fax:
Practice Address - Street 1:424 MCARTHUR RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6924
Practice Address - Country:US
Practice Address - Phone:910-868-2002
Practice Address - Fax:910-868-2004
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP18213OtherPHYSICAL THERAPY LICENSE