Healthcare Provider Details

I. General information

NPI: 1750375952
Provider Name (Legal Business Name): COLORADO ABELLA PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MAYNARDVILLE HWY STE. 9
MAYNARDVILLE TN
37807-3251
US

IV. Provider business mailing address

1733 DANCING LIGHT LN
KNOXVILLE TN
37922-5715
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-6933
  • Fax: 865-992-6870
Mailing address:
  • Phone: 865-250-2340
  • Fax: 865-992-6870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0000003293
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT0000003293
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT0000003293
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT0000003293
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: