Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1712 | AZ |
N | 2251C2600X | Cardiopulmonary | 1712 | AZ |
N | 2251E1300X | Electrophysiology, Clinical | 1712 | AZ |
N | 2251G0304X | Physical Therapist - Geriatrics | 1712 | AZ |
N | 2251N0400X | Physical Therapist - Neurology | 1712 | AZ |
N | 2251P0200X | Physical Therapist - Pediatrics | 1712 | AZ |
N | 2251S0007X | Physical Therapist - Sports | 1712 | AZ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 1712 | AZ |
NPI | 1033325915 |
---|---|
Provider Name | Peter J Colla |
First Address | Phoenix, AZ 85086-9155 |
Second Address | Phoenix, AZ 85086-9155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
782880 | (05) | AZ |
R09494 | (02) |