Provider Demographics
NPI:1629619457
Name:COLCLASURE, ANDREA F (RRT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:F
Last Name:COLCLASURE
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 TIMBER ROCK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-7059
Mailing Address - Country:US
Mailing Address - Phone:214-458-7793
Mailing Address - Fax:972-775-3228
Practice Address - Street 1:2821 TIMBER ROCK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-7059
Practice Address - Country:US
Practice Address - Phone:214-458-7793
Practice Address - Fax:972-775-3228
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62801227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered