Healthcare Provider Details

I. General information

NPI: 1225228406
Provider Name (Legal Business Name): ELIZABETH ROSE COLBURN MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E VIRGINIA AVE #200
PHOENIX AZ
85004-1214
US

IV. Provider business mailing address

370 E VIRGINIA AVE #200
PHOENIX AZ
85004-1214
US

V. Phone/Fax

Practice location:
  • Phone: 602-222-5605
  • Fax: 602-532-7839
Mailing address:
  • Phone: 602-222-5605
  • Fax: 602-532-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0216
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: