Provider Demographics
NPI:1790904274
Name:COLINA, RAY-AN (PT)
Entity Type:Individual
Prefix:MS
First Name:RAY-AN
Middle Name:
Last Name:COLINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HEAVRIN CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2983
Mailing Address - Country:US
Mailing Address - Phone:410-529-0192
Mailing Address - Fax:
Practice Address - Street 1:11350 MCCORMICK RD
Practice Address - Street 2:SUITE 503
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1002
Practice Address - Country:US
Practice Address - Phone:410-771-6868
Practice Address - Fax:410-771-8444
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist