Provider Demographics
NPI:1689881302
Name:MEYER, COLIN R (LMP, NCTMB)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:R
Last Name:MEYER
Suffix:
Gender:M
Credentials:LMP, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SE SUMMIT CT
Mailing Address - Street 2:SUMMIT THERAPY
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5540
Mailing Address - Country:US
Mailing Address - Phone:509-332-5106
Mailing Address - Fax:
Practice Address - Street 1:1620 SE SUMMIT CT
Practice Address - Street 2:SUMMIT THERAPY
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5540
Practice Address - Country:US
Practice Address - Phone:509-332-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist