Provider Demographics
NPI:1770658312
Name:STEVEN G COLWELL
Entity Type:Organization
Organization Name:STEVEN G COLWELL
Other - Org Name:SOUTHSHORE REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:COLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CPO BOCO LPO
Authorized Official - Phone:206-440-1811
Mailing Address - Street 1:6509 NE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4801
Mailing Address - Country:US
Mailing Address - Phone:206-440-1811
Mailing Address - Fax:425-488-3025
Practice Address - Street 1:6509 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4801
Practice Address - Country:US
Practice Address - Phone:206-440-1811
Practice Address - Fax:425-488-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9031865Medicaid
WA4533580001Medicare NSC