Provider Demographics
NPI:1831347319
Name:MYERS, COLIN (MED, ATC/L)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:MED, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 86 BOX 400
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-9715
Mailing Address - Country:US
Mailing Address - Phone:304-962-3516
Mailing Address - Fax:866-280-0285
Practice Address - Street 1:9990 PARK MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6739
Practice Address - Country:US
Practice Address - Phone:304-962-3516
Practice Address - Fax:866-280-0285
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0011882255A2300X
VA01260016542255A2300X
AL9442255A2300X
0606022682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer