Provider Demographics
NPI:1891958872
Name:COLELLA, CARLA (DPT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:COLELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 E MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 W KAAHUMANU AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1623
Practice Address - Country:US
Practice Address - Phone:202-256-4115
Practice Address - Fax:808-579-9751
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12240955OtherCAQH