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Individual

MR. RICHARD SHANE COLTRAIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CPO

Contact information

Practice address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216
Mailing address
1025 WH SMITH BLVD, SUITE 108, GREENVILLE, NC 27834-5052
(252) 215-2215
(252) 215-2216

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
CPO 2469
VA
224P00000X
Prosthetist
Primary
CPO 2469
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0464J
NC BCBS PROVIDER#
NC
05
7795272
NC
01
ABC CPO 2469
INDIVIDUAL ABC CERTIFICATION#
NC
Enumeration date
05/31/2006
Last updated
04/03/2013
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