Provider Demographics
NPI:1295732469
Name:COLHARD, SANDRA C (PT, CHT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:COLHARD
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-236-2758
Mailing Address - Fax:706-802-1408
Practice Address - Street 1:201 TURNER MCCALL BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2545
Practice Address - Country:US
Practice Address - Phone:706-236-2758
Practice Address - Fax:706-802-1408
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT000748225100000X
GA91050002292251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00359217OtherRR MEDICARE
GA65BBDJFMedicare PIN