Provider Demographics
NPI:1235769399
Name:KOLBUCK, VIRGINIA ROSE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ROSE
Last Name:KOLBUCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ROSE
Other - Last Name:BEATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:10 PEBBLE POCKET CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25420 KUYKENDAHL RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77375-3405
Practice Address - Country:US
Practice Address - Phone:708-525-7857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2127970225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant