Provider Demographics
NPI:1891242285
Name:COLBORNE, JESSICA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:COLBORNE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 JOHN TYLER CIR
Mailing Address - Street 2:APT 201
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-2582
Mailing Address - Country:US
Mailing Address - Phone:540-271-8302
Mailing Address - Fax:
Practice Address - Street 1:261 BLUESTONE DR
Practice Address - Street 2:DEPARTMENT OF SPORTS MEDICINE, MSC 2301
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22807-1009
Practice Address - Country:US
Practice Address - Phone:540-568-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260026112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer