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NPI Code Detail

MEDICARE: MR. COLBY MARSHALL ALLEN MPT

MEDICARE: MR. COLBY MARSHALL ALLEN MPT
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
1225100000XPhysical Therapist05008605AIN
2225100000XPhysical Therapist004774KY
3225100000XPhysical TherapistPT009829GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000064465OTHERINBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558442087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COLBY MARSHALL ALLEN MPT
Provider Business Mailing Address
First Line : 611 HIGHWAY 74 S
Second Line : SUITE 720
City : PEACHTREE CITY
State : GA
Zip : 30269-3081
Country : US
Telephone Number : 770-632-6800
Fax Number : 770-632-6060
Provider Business Practice Location Address
First Line : 611 HIGHWAY 74 S
Second Line : SUITE 720
City : PEACHTREE CITY
State : GA
Zip : 30269-3081
Country : US
Telephone Number : 770-632-6800
Fax Number : 770-632-6060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 11/13/2009

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