Provider Demographics
NPI:1972177731
Name:COLOMB, CARRICK (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CARRICK
Middle Name:
Last Name:COLOMB
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SHANANDOAH LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4258
Mailing Address - Country:US
Mailing Address - Phone:469-367-9697
Mailing Address - Fax:
Practice Address - Street 1:120 SHANANDOAH LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4258
Practice Address - Country:US
Practice Address - Phone:469-367-9697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1327870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty