Provider Demographics
NPI:1225228406
Name:COLBURN, ELIZABETH ROSE (MS, ATC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E VIRGINIA AVE
Mailing Address - Street 2:#200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1214
Mailing Address - Country:US
Mailing Address - Phone:602-222-5605
Mailing Address - Fax:602-532-7839
Practice Address - Street 1:370 E VIRGINIA AVE
Practice Address - Street 2:#200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1214
Practice Address - Country:US
Practice Address - Phone:602-222-5605
Practice Address - Fax:602-532-7839
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ02162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer