Provider Demographics
NPI:1295601201
Name:KOLESAR, BENJAMIN FRANK
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FRANK
Last Name:KOLESAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 BONNEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1701
Mailing Address - Country:US
Mailing Address - Phone:360-217-8256
Mailing Address - Fax:
Practice Address - Street 1:1429 BONNEVILLE AVE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1701
Practice Address - Country:US
Practice Address - Phone:360-217-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA70025576225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty