Basic Information
| Provider Information | |||||||||
| NPI: | 1336270289 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLONIAL ORTHOPAEDICS, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLONIAL ORTHOPAEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13000 RIVERS BEND BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238368632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045715000 | ||||||||
| FaxNumber: | 8045181314 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 JENNICK DR | ||||||||
| Address2: | |||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238344905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045265888 | ||||||||
| FaxNumber: | 8045265401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 02/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | ALVIS | ||||||||
| AuthorizedOfficialFirstName: | DEE DEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8045715132 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 0119000261 | VA | N | Ambulatory Health Care Facilities | Clinic/Center | 261QP2000X | 2305005628 | VA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | 182898 | 01 | VA | SOUTHERN HEALTH PT OT | OTHER | 194507 | 01 | VA | ANTHEM PT | OTHER | 5654515 | 01 | VA | FIRST HEALTH MAILHANDLERS | OTHER | 194508 | 01 | VA | ANTHEM OT | OTHER | 10002763 | 01 | VA | OPTIMA PT | OTHER |