Provider Demographics
NPI:1336270289
Name:COLONIAL ORTHOPAEDICS, INC
Entity type:Organization
Organization Name:COLONIAL ORTHOPAEDICS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-571-5132
Mailing Address - Street 1:13000 RIVERS BEND BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5000
Mailing Address - Fax:804-518-1314
Practice Address - Street 1:131 JENNICK DR
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-4905
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:804-526-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119000261261Q00000X
VA2305005628261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182898OtherSOUTHERN HEALTH PT OT
VA194507OtherANTHEM PT
VA5654515OtherFIRST HEALTH MAILHANDLERS
VA194508OtherANTHEM OT
VA10002763OtherOPTIMA PT
VA194507OtherANTHEM PT
VA005284C67Medicare ID - Type UnspecifiedA. SCHWEITZER