Individual
COLONIE ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 S MAIN ST, FORT BRAGG, CA 95437-4210
(707) 463-3300
Mailing address
215 S MAIN ST, FORT BRAGG, CA 95437-4210
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
02/17/2026
Last updated
02/17/2026
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