Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT0000003293 | TN |
N | 2251N0400X | Physical Therapist - Neurology | PT0000003293 | TN |
N | 2251S0007X | Physical Therapist - Sports | PT0000003293 | TN |
N | 2251X0800X | Physical Therapist - Orthopedic | PT0000003293 | TN |
NPI | 1750375952 |
---|---|
Provider Name | Colorado Abella |
First Address | Knoxville, TN 37922-5715 |
Second Address | Maynardville, TN 37807-3251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 08/07/2007 |