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General NPI Number Information
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NPI Number | 1023651452
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Entity Type | Individual
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Provider Name | NINA THERESE SITCHON COLOSO
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 10524 EUCLID AVE C BUILDING
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City | CLEVELAND
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State | OH
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Zip | 44195-2202
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Country | US
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Telephone | 216-444-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 2193 LEWIS DR
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City | LAKEWOOD
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State | OH
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Zip | 44107-6142
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Country | US
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Telephone | 479-739-1396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT34875
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018332
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License Number State | OH
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