Provider Demographics
NPI:1740861103
Name:COLOMBO, THOMAS JAMES (ATC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:COLOMBO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 BLUFF SPRINGS RD APT 4413
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-0068
Mailing Address - Country:US
Mailing Address - Phone:845-216-2435
Mailing Address - Fax:
Practice Address - Street 1:7330 BLUFF SPRINGS RD APT 4413
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-0068
Practice Address - Country:US
Practice Address - Phone:845-216-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-17
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT85762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer