Provider Demographics
NPI:1316288566
Name:COLYER, RONALD GLENN JR (LMP)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GLENN
Last Name:COLYER
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17771 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8751
Mailing Address - Country:US
Mailing Address - Phone:425-466-3140
Mailing Address - Fax:
Practice Address - Street 1:160 CASCADE PL
Practice Address - Street 2:SUITE 106
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3126
Practice Address - Country:US
Practice Address - Phone:360-941-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60331538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist