Provider Demographics
NPI:1609107598
Name:COLVIN, KEVIN RENEE (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RENEE
Last Name:COLVIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL RD
Mailing Address - Street 2:STE 103
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4029
Mailing Address - Country:US
Mailing Address - Phone:301-567-8856
Mailing Address - Fax:
Practice Address - Street 1:3010 CRAIN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2801
Practice Address - Country:US
Practice Address - Phone:301-567-8856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist