Provider Demographics
NPI:1164750154
Name:KOLA, BRUCE (MS ATC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:KOLA
Suffix:
Gender:M
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E CACHE LA POUDRE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3243
Mailing Address - Country:US
Mailing Address - Phone:719-389-6813
Mailing Address - Fax:
Practice Address - Street 1:14 E CACHE LA POUDRE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3243
Practice Address - Country:US
Practice Address - Phone:719-389-6813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer