Active NPI
Marlene Elizabeth Colburn, DPT
- Physical Therapist
- Purvis, MS
National Provider Identifier
1164705463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4972
- Practice address
- 98 Shelby Speights Dr
Purvis, MS 39475-4528 - Phone
- (601) 794-2402
- Fax
- (601) 794-2404
- NPI assigned
- Sep 22, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT4972 | MS | Primary |
Addresses
Primary practice location
98 Shelby Speights Dr
Purvis, MS 39475-4528
Mailing address
98 Shelby Speights Dr
Purvis, MS 39475-4528
Phone (601) 794-2402
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06929043 | Medicaid | MS | |
| 9005774 | Other | MS | AETNA |
| P01022232 | Other | MS | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT4972 | MS | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338336000000",
"number": "1164705463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98 SHELBY SPEIGHTS DR",
"city": "PURVIS",
"state": "MS",
"postal_code": "394754528",
"telephone_number": "601-794-2402",
"fax_number": "601-794-2404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98 SHELBY SPEIGHTS DR",
"city": "PURVIS",
"state": "MS",
"postal_code": "394754528",
"telephone_number": "601-794-2402",
"fax_number": "601-794-2404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLBURN",
"first_name": "MARLENE",
"middle_name": "ELIZABETH",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-22",
"last_updated": "2012-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MS",
"license": "PT4972",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06929043",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9005774",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01022232",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Purvis, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.