Provider Demographics
NPI:1649476458
Name:WOLFORD, COLLEEN DENISE (PT)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:DENISE
Last Name:WOLFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9024
Mailing Address - Country:US
Mailing Address - Phone:740-845-1261
Mailing Address - Fax:
Practice Address - Street 1:218 ELM ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-2130
Practice Address - Country:US
Practice Address - Phone:740-852-3100
Practice Address - Fax:740-852-7266
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist