Healthcare Provider Details

I. General information

NPI: 1043219264
Provider Name (Legal Business Name): CAROLINE TIMONEY COLVIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 BURNET AVE # 4007
CINCINNATI OH
45229-2833
US

IV. Provider business mailing address

3430 BURNET AVE # 4007
CINCINNATI OH
45229-2833
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-4769
  • Fax: 859-344-4771
Mailing address:
  • Phone:
  • Fax: 859-344-4771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number003516
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: