MEDICARE: JOSE COLQUITT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P18213	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P18213	OTHER	NC	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1497308423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE COLQUITT

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-6924
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-6924
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:

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

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	11/18/2024

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Directions to “ JOSE COLQUITT ” Practice Location

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