Provider Demographics
NPI:1639694466
Name:SHOWALTER, COLIN DAVID (DPT)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:DAVID
Last Name:SHOWALTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S PALM AVE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-7746
Mailing Address - Country:US
Mailing Address - Phone:941-330-1677
Mailing Address - Fax:941-330-1688
Practice Address - Street 1:2055 WOOD ST STE 110
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7928
Practice Address - Country:US
Practice Address - Phone:941-330-1677
Practice Address - Fax:941-330-1688
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist