Provider Demographics
NPI:1609007111
Name:GEST, COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:GEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:756 W CATTLE DRIVE TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-6970
Mailing Address - Country:US
Mailing Address - Phone:928-925-8146
Mailing Address - Fax:
Practice Address - Street 1:403 W BIRCH AVE
Practice Address - Street 2:# 1
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4467
Practice Address - Country:US
Practice Address - Phone:928-925-8146
Practice Address - Fax:928-216-4073
Is Sole Proprietor?:No
Enumeration Date:2009-07-31
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-008577225100000X
AZ8577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist