MEDICARE: PETER J COLLA P.T.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1712	AZ
2	2251X0800X	Orthopedic Physical Therapist	1712	AZ
3	2251S0007X	Sports Physical Therapist	1712	AZ
4	2251E1300X	Clinical Electrophysiology Physical Therapist	1712	AZ
5	2251G0304X	Geriatric Physical Therapist	1712	AZ
6	2251C2600X	Cardiopulmonary Physical Therapist	1712	AZ
7	2251P0200X	Pediatric Physical Therapist	1712	AZ
8	2251N0400X	Neurology Physical Therapist	1712	AZ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1033325915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J COLLA P.T.

Provider Business Mailing Address
First Line	:	3445 W VALLEY VIEW TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-9155
Country	:	US
Telephone Number	:	602-315-6894
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 W VALLEY VIEW TRL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-9155
Country	:	US
Telephone Number	:	602-315-6894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	12/04/2012

9155 N 3RD ST
PHOENIX, AZ
85020

Practice Phone: 602-218-9483
Practice Fax: 602-944-8549