Provider Demographics
NPI:1770861098
Name:COLBURN, COLLEEN (LMT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COLBURN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-8230
Mailing Address - Country:US
Mailing Address - Phone:775-354-7318
Mailing Address - Fax:775-562-4785
Practice Address - Street 1:1525 W WILLIAMS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2606
Practice Address - Country:US
Practice Address - Phone:775-354-7318
Practice Address - Fax:775-562-4785
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist