Individual
MARLENE ELIZABETH COLBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
98 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4528
(601) 794-2402
(601) 794-2404
Mailing address
98 SHELBY SPEIGHTS DR, PURVIS, MS 39475-4528
(601) 794-2402
(601) 794-2404
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4972
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06929043
—
MS
01
—
9005774
AETNA
MS
01
—
P01022232
RAILROAD MEDICARE
MS
Enumeration date
09/22/2011
Last updated
05/30/2012
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