Healthcare Provider Details

I. General information

NPI: 1528332699
Provider Name (Legal Business Name): TRIVIA COLEY DPT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 TERRA MANGO LOOP STE 200
ORLANDO FL
32835-8509
US

IV. Provider business mailing address

133 TERRA MANGO LOOP STE 200
ORLANDO FL
32835-8509
US

V. Phone/Fax

Practice location:
  • Phone: 321-335-6510
  • Fax:
Mailing address:
  • Phone: 478-279-4460
  • Fax: 321-335-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: