Provider Demographics
NPI:1124297858
Name:COLONIAL THERAPY CENTER
Entity type:Organization
Organization Name:COLONIAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CH6817
Authorized Official - Phone:239-275-3330
Mailing Address - Street 1:4531 DELEON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1280
Mailing Address - Country:US
Mailing Address - Phone:239-275-3330
Mailing Address - Fax:239-275-3339
Practice Address - Street 1:4531 DELEON ST STE 203
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1280
Practice Address - Country:US
Practice Address - Phone:239-275-3330
Practice Address - Fax:239-275-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111NR0400X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center