Provider Demographics
NPI:1750417184
Name:RADUN, COLLEEN MARIE (PT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:RADUN
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 1:3288 CROOKED TREE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7957
Mailing Address - Country:US
Mailing Address - Phone:513-754-0188
Mailing Address - Fax:
Practice Address - Street 1:8603 CINCINNATI COLUMBUS RD STE J
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3569
Practice Address - Country:US
Practice Address - Phone:513-779-7999
Practice Address - Fax:513-898-1598
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist