1891958872 NPI number — CARLA COLELLA DPT

Table of content: CARLA COLELLA DPT (NPI 1891958872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891958872 NPI number — CARLA COLELLA DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLELLA
Provider First Name:
CARLA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

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:
1891958872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9019 E MOUNTAINVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARDON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44024-9624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
285 W KAAHUMANU AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-256-4115
Provider Business Practice Location Address Fax Number:
808-579-9751
Provider Enumeration Date:
07/09/2008

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: 225100000X , with the licence number:  2305205523 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12240955 . This is a "CAQH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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