Provider Demographics
NPI:1902036353
Name:INDERMILL, COLLEEN LEE (RPT)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:LEE
Last Name:INDERMILL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27225 CAMP PLENTY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2654
Mailing Address - Country:US
Mailing Address - Phone:661-298-0140
Mailing Address - Fax:661-298-1207
Practice Address - Street 1:27225 CAMP PLENTY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-2654
Practice Address - Country:US
Practice Address - Phone:661-298-0140
Practice Address - Fax:661-298-1207
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist