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General NPI Number Information
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NPI Number | 1538392139
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Entity Type | Individual
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Provider Name | COLBY THOMAS DELATOUR P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 910 20TH ST
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City | GOTHENBURG
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State | NE
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Zip | 69138-1237
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Country | US
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Telephone | 308-537-4023
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Fax |
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Provider Business Mailing Address
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Address Line | 32830 ROAD 761
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City | GRANT
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State | NE
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Zip | 69140-3202
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Country | US
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Telephone | 308-352-2540
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 513
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License Number State | NE
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