Provider Demographics
NPI:1962430538
Name:COLSON, JEANETTE LEE
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:LEE
Last Name:COLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W 15TH ST
Mailing Address - Street 2:BOX 629
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7523
Mailing Address - Country:US
Mailing Address - Phone:972-612-9105
Mailing Address - Fax:972-612-9172
Practice Address - Street 1:2800 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7526
Practice Address - Country:US
Practice Address - Phone:972-612-9105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2547208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF41127Medicare UPIN
TX80V671Medicare ID - Type Unspecified