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General NPI Number Information
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NPI Number | 1811311343
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Entity Type | Organization
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Legal Business Name | COLONIAL ORTHOPAEDICS INC
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 325 CHARLES DIMMOCK PARKWAY SUITE 301
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834
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Country | US
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Telephone | 804-526-5888
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Fax | 804-526-5401
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Provider Business Mailing Address
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Address Line | 325 CHARLES H DIMMOCK PKWY STE 100
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2986
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Country | US
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Telephone | 804-571-5106
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Fax | 804-530-3015
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JENNIFER BAILEY
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Credential |
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Telephone | 804-571-5106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101036726
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 0101226595
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 0101231604
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 0101237849
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 0101045456
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 0101052925
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License Number State | VA
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Taxonomy #7
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101222130
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License Number State | VA
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Taxonomy #8
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 0101235833
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License Number State | VA
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Taxonomy #9
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 0101224513
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License Number State | VA
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Taxonomy #10
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103000995
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License Number State | VA
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Taxonomy #11
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305005628
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License Number State | VA
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Taxonomy #12
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306601247
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License Number State | VA
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Taxonomy #13
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 0119000261
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License Number State | VA
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Taxonomy #14
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003073
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License Number State | VA
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Taxonomy #15
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101034297
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License Number State | VA
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