MEDICARE: KANDICE MINOR COLBERT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2035204772	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K949 - 0018	OTHER	VA	CAREFIRST
2	2307000356	OTHER	VA	DIRECT ACCESS CERTIFICATION

General Provider Information

NPI Number	:	1518166305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDICE MINOR COLBERT PT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 DUKE ST # 4
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4518
Country	:	US
Telephone Number	:	571-317-6792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	11/19/2025

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