Healthcare Provider Details

I. General information

NPI: 1043228778
Provider Name (Legal Business Name): MARK COLKITT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 CLIFTON ST
LYNCHBURG VA
24501-1422
US

IV. Provider business mailing address

44 CLIFTON ST
LYNCHBURG VA
24501-1422
US

V. Phone/Fax

Practice location:
  • Phone: 434-528-1848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203357
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: