Provider Demographics
NPI:1528332699
Name:COLEY, TRIVIA (DPT, CLT)
Entity type:Individual
Prefix:DR
First Name:TRIVIA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:DPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 BERRY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5966
Mailing Address - Country:US
Mailing Address - Phone:478-279-4460
Mailing Address - Fax:321-710-9958
Practice Address - Street 1:931 BERRY LEAF CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5966
Practice Address - Country:US
Practice Address - Phone:478-279-4460
Practice Address - Fax:321-710-9958
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist