Provider Demographics
NPI:1386981496
Name:COLWELL, BENJAMIN RAY (MS, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:RAY
Last Name:COLWELL
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 STAFFORD INDIANS LN
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:22405-5803
Mailing Address - Country:US
Mailing Address - Phone:540-371-7200
Mailing Address - Fax:
Practice Address - Street 1:33 STAFFORD INDIANS LN
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:VA
Practice Address - Zip Code:22405-5803
Practice Address - Country:US
Practice Address - Phone:540-371-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260009012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer