MEDICARE: COLONIAL ORTHOPAEDICS, INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	0101045456	VA
2	207X00000X	Orthopaedic Surgery Physician	0101034297	VA
3	207X00000X	Orthopaedic Surgery Physician	0101036726	VA
4	207XS0106X	Orthopaedic Hand Surgery Physician	0101226595	VA
5	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	0101231604	VA
6	207XS0117X	Orthopaedic Surgery of the Spine Physician	0101237849	VA
7	208100000X	Physical Medicine & Rehabilitation Physician	0101222130	VA
8	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	0101235833	VA
9	225100000X	Physical Therapist	2305005628	VA
10	225200000X	Physical Therapy Assistant	2306601247	VA
11	225XH1200X	Hand Occupational Therapist	0119000261	VA
12	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	0101052925	VA

NPI Number	:	1568406825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLONIAL ORTHOPAEDICS, INC

Provider Business Mailing Address
First Line	:	13000 RIVERS BEND BLVD
Second Line	:	STE D
City	:	CHESTER
State	:	VA
Zip	:	23836
Country	:	US
Telephone Number	:	804-571-5000
Fax Number	:	804-518-1314

Provider Business Practice Location Address
First Line	:	131 JENNICK DR
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-4905
Country	:	US
Telephone Number	:	804-526-5888
Fax Number	:	804-526-5401

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. DEE DEE ALVIS
Credential	:
Telephone Number	:	804-571-5132

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	02/19/2014