Provider Demographics
NPI:1194809673
Name:COLON, MARLY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:MARLY
Middle Name:ANN
Last Name:COLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5226 ANGELO CIR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-9024
Mailing Address - Country:US
Mailing Address - Phone:407-247-4454
Mailing Address - Fax:
Practice Address - Street 1:4141 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2131
Practice Address - Country:US
Practice Address - Phone:863-385-6119
Practice Address - Fax:863-385-9698
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 8227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist