Provider Demographics
NPI:1558609610
Name:COLGAN, ADINA LYN
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:LYN
Last Name:COLGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 W CHARLESTON BLVD
Mailing Address - Street 2:1084
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1245
Mailing Address - Country:US
Mailing Address - Phone:702-201-4193
Mailing Address - Fax:
Practice Address - Street 1:8301 W CHARLESTON BLVD
Practice Address - Street 2:1084
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1245
Practice Address - Country:US
Practice Address - Phone:702-201-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner