Provider Demographics
NPI:1831310242
Name:NORDSTROM, COLIN MATTHEW (MPT)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:MATTHEW
Last Name:NORDSTROM
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OAKLANDS DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4029
Mailing Address - Country:US
Mailing Address - Phone:707-771-5160
Mailing Address - Fax:
Practice Address - Street 1:701 OAKLANDS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4029
Practice Address - Country:US
Practice Address - Phone:707-771-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11620802251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic