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General NPI Number Information
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NPI Number | 1922625094
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Entity Type | Individual
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Provider Name | COLTEN POELLINGER PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 4516B CHAMBLEE DUNWOODY RD # 22
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City | ATLANTA
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State | GA
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Zip | 30338-6202
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Country | US
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Telephone | 678-459-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 4516B CHAMBLEE DUNWOODY RD # 22
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City | ATLANTA
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State | GA
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Zip | 30338-6202
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Country | US
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Telephone |
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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 | 1332361
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License Number State | TX
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