Provider Demographics
NPI:1568605590
Name:COLOMA, MARIBETH LYN MAGANA (PT)
Entity Type:Individual
Prefix:
First Name:MARIBETH LYN
Middle Name:MAGANA
Last Name:COLOMA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CARROLL SQ
Mailing Address - Street 2:APT 2E #6
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-1574
Mailing Address - Country:US
Mailing Address - Phone:912-387-5780
Mailing Address - Fax:
Practice Address - Street 1:650 CARROLL SQ
Practice Address - Street 2:APT 2E #6
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-1574
Practice Address - Country:US
Practice Address - Phone:912-387-5780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009453225100000X
IL070019073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist