=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942278254
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDY MARIE COLABELLA D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2006
-----------------------------------------------------
Last Update Date | 08/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 S MASON RD STE B5
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-507-0732
-----------------------------------------------------
Fax | 877-890-4365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 S MASON RD SUITE B-5
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-507-0732
-----------------------------------------------------
Fax | 877-890-4365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | H2053
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------