1770169658 NPI number — AXEL EDGARDO COLON PADIN OTR/L

Table of content: AXEL EDGARDO COLON PADIN OTR/L (NPI 1770169658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770169658 NPI number — AXEL EDGARDO COLON PADIN OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLON PADIN
Provider First Name:
AXEL
Provider Middle Name:
EDGARDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770169658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 DUNBAR CAVE RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-8850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-542-2739
Provider Business Mailing Address Fax Number:
931-233-9970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 DUNBAR CAVE RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37043-8850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-333-6148
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  6759 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com