Provider Demographics
NPI:1942278254
Name:COLABELLA, JUDY MARIE (DO)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:COLABELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MASON RD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3863
Mailing Address - Country:US
Mailing Address - Phone:281-507-0732
Mailing Address - Fax:877-890-4365
Practice Address - Street 1:830 S MASON RD STE B5
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3863
Practice Address - Country:US
Practice Address - Phone:281-507-0732
Practice Address - Fax:877-890-4365
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2053204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612316Medicare PIN
TXE08802Medicare UPIN