Healthcare Provider Details

I. General information

NPI: 1144144619
Provider Name (Legal Business Name): COLTON DURCHOLZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 BEVINS LN STE F
GEORGETOWN KY
40324-6129
US

IV. Provider business mailing address

208 BEVINS LN STE F
GEORGETOWN KY
40324-6129
US

V. Phone/Fax

Practice location:
  • Phone: 502-863-4242
  • Fax: 502-570-9813
Mailing address:
  • Phone: 502-863-4242
  • Fax: 502-570-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009592
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: