Provider Demographics
NPI:1528164183
Name:CHRIS COLBERG PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CHRIS COLBERG PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-324-0681
Mailing Address - Street 1:3655 BRIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6812
Mailing Address - Country:US
Mailing Address - Phone:775-324-0681
Mailing Address - Fax:775-324-0681
Practice Address - Street 1:3655 BRIGHTON WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6812
Practice Address - Country:US
Practice Address - Phone:775-324-0681
Practice Address - Fax:775-324-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101811Medicare ID - Type Unspecified