Provider Demographics
NPI:1215183223
Name:KOLB CORPORATION
Entity Type:Organization
Organization Name:KOLB CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:585-678-4713
Mailing Address - Street 1:481 PENBROOKE DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2044
Mailing Address - Country:US
Mailing Address - Phone:585-678-4713
Mailing Address - Fax:585-678-4713
Practice Address - Street 1:481 PENBROOKE DR
Practice Address - Street 2:SUITE 5
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2044
Practice Address - Country:US
Practice Address - Phone:585-678-4713
Practice Address - Fax:585-678-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-10
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty