Healthcare Provider Details

I. General information

NPI: 1114149960
Provider Name (Legal Business Name): TONYA MICHELLE COLWELL P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 HEARTLAND RD
SAINT JOSEPH MO
64506-3492
US

IV. Provider business mailing address

2215 GARFIELD AVE
SAINT JOSEPH MO
64503-3243
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-8506
  • Fax:
Mailing address:
  • Phone: 816-233-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2000174569
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: