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General NPI Number Information
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NPI Number | 1679184691
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Entity Type | Individual
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Provider Name | KATHY COLLADO DPT
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Gender | Female
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 2580 PRUDEN BLVD
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City | SUFFOLK
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State | VA
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Zip | 23434-4229
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Country | US
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Telephone | 619-709-8253
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 GRANBY ST APT 351
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City | NORFOLK
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State | VA
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Zip | 23510-2652
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Country | US
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Telephone | 619-709-8253
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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 | 298457
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License Number State | CA
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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 | 2305213720
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License Number State | VA
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