Provider Demographics
NPI:1265020556
Name:KOLEV, IVAN (PT)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:KOLEV
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 MILLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1261
Mailing Address - Country:US
Mailing Address - Phone:803-851-3506
Mailing Address - Fax:803-619-9551
Practice Address - Street 1:2829 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1261
Practice Address - Country:US
Practice Address - Phone:803-851-3506
Practice Address - Fax:803-619-9551
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist