Provider Demographics
NPI:1700556941
Name:COLWELL, EPHRAIM (LMT)
Entity Type:Individual
Prefix:
First Name:EPHRAIM
Middle Name:
Last Name:COLWELL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 CYPRESS NORTH HOUSTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4081
Mailing Address - Country:US
Mailing Address - Phone:832-423-9822
Mailing Address - Fax:
Practice Address - Street 1:11810 CYPRESS NORTH HOUSTON RD STE B
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4081
Practice Address - Country:US
Practice Address - Phone:832-423-9822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT038263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist