MEDICARE: JUDY MARIE COLABELLA D.O.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	H2053	TX

General Provider Information

NPI Number	:	1942278254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY MARIE COLABELLA D.O.

Provider Business Mailing Address
First Line	:	830 S MASON RD
Second Line	:	SUITE B-5
City	:	KATY
State	:	TX
Zip	:	77450-3863
Country	:	US
Telephone Number	:	281-507-0732
Fax Number	:	877-890-4365

Provider Business Practice Location Address
First Line	:	830 S MASON RD STE B5
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-3863
Country	:	US
Telephone Number	:	281-507-0732
Fax Number	:	877-890-4365

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/27/2012

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