Provider Demographics
NPI:1558442087
Name:ALLEN, COLBY MARSHALL (MPT)
Entity Type:Individual
Prefix:MR
First Name:COLBY
Middle Name:MARSHALL
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HIGHWAY 74 S
Mailing Address - Street 2:SUITE 720
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3081
Mailing Address - Country:US
Mailing Address - Phone:770-632-6800
Mailing Address - Fax:770-632-6060
Practice Address - Street 1:611 HIGHWAY 74 S
Practice Address - Street 2:SUITE 720
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3081
Practice Address - Country:US
Practice Address - Phone:770-632-6800
Practice Address - Fax:770-632-6060
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008605A225100000X
KY004774225100000X
GAPT009829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000064465OtherBCBS
IN200816690Medicaid
IN156514Medicare ID - Type Unspecified