Provider Demographics
NPI:1750799656
Name:NOLLIN, COLBY
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:NOLLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLBY
Other - Middle Name:
Other - Last Name:WHITTEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:
Practice Address - Street 1:34572 N US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:THIRD LAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-4037
Practice Address - Country:US
Practice Address - Phone:847-548-3695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist