Provider Demographics
NPI:1457365744
Name:COLBURN, KRISNA NIKKA RECOMETA (MPT)
Entity type:Individual
Prefix:MRS
First Name:KRISNA NIKKA
Middle Name:RECOMETA
Last Name:COLBURN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:KRISNA
Other - Middle Name:NIKKA
Other - Last Name:RECOMETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:8600 SNOWDEN RIVER PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1982
Mailing Address - Country:US
Mailing Address - Phone:410-720-5555
Mailing Address - Fax:410-381-4653
Practice Address - Street 1:8600 SNOWDEN RIVER PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1982
Practice Address - Country:US
Practice Address - Phone:410-720-5555
Practice Address - Fax:410-381-4653
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2275307OtherFIRST HEALTH NETWORK
MD610334-05OtherBLUECROSS BLUESHIELD MD
MDT6710016OtherBLUECROSS BLUESHIELD DC
MD147433401OtherACS / US DEPT OF LABOR
MD2470862OtherUNITED HEALTHCARE
MD5552701OtherCCN NETWORK
MD684017OtherNCPPO
MD2128468OtherMAMSI
MD57731OtherJOHN HOPKINS HEALTHCARE
MD756LK343Medicare ID - Type Unspecified
MD5552701OtherCCN NETWORK