Provider Demographics
NPI:1629139514
Name:VIRGILIO, COLLEEN JOY (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOY
Last Name:VIRGILIO
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 1:15322 FLYING B ROAD
Mailing Address - Street 2:
Mailing Address - City:OAK RUN
Mailing Address - State:CA
Mailing Address - Zip Code:96069
Mailing Address - Country:US
Mailing Address - Phone:530-472-1159
Mailing Address - Fax:
Practice Address - Street 1:2120 BENTON DR
Practice Address - Street 2:CANYONWOOD NURSING & REHABILITATION CENTER
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002
Practice Address - Country:US
Practice Address - Phone:530-243-6317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist