Provider Demographics
NPI:1508161407
Name:POWELL, COLLEEN PATRICIA (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:PATRICIA
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15860 IROQUOIS DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:IL
Mailing Address - Zip Code:60442-1705
Mailing Address - Country:US
Mailing Address - Phone:815-531-7291
Mailing Address - Fax:
Practice Address - Street 1:15860 IROQUOIS DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:IL
Practice Address - Zip Code:60442-1705
Practice Address - Country:US
Practice Address - Phone:815-531-7291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist