Provider Demographics
NPI:1558630087
Name:COLBURN, MICHAEL P (LPTA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:COLBURN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 NE 151ST AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-8221
Mailing Address - Country:US
Mailing Address - Phone:360-609-6124
Mailing Address - Fax:
Practice Address - Street 1:3812 NE 151ST AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-8221
Practice Address - Country:US
Practice Address - Phone:360-609-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60039334225200000X
OR7706225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant