Provider Demographics
NPI:1326520040
Name:KOLTE, ROHAN
Entity Type:Individual
Prefix:
First Name:ROHAN
Middle Name:
Last Name:KOLTE
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 1:620 N HEWITT DR APT 24
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-2912
Mailing Address - Country:US
Mailing Address - Phone:979-703-0628
Mailing Address - Fax:
Practice Address - Street 1:9114 ROYAL LN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8469
Practice Address - Country:US
Practice Address - Phone:254-666-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1272320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist