Provider Demographics
NPI:1427475383
Name:COLBURN, SHENA (PTA)
Entity type:Individual
Prefix:
First Name:SHENA
Middle Name:
Last Name:COLBURN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 DELWOOD DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-1579
Mailing Address - Country:US
Mailing Address - Phone:440-638-4506
Mailing Address - Fax:440-638-4506
Practice Address - Street 1:19502 PEARL ROAD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-638-4506
Practice Address - Fax:440-638-4506
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08972225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant