Provider Demographics
NPI:1417159708
Name:KOLEK, KACEY (PT)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:KOLEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4929 MOBILE HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-3229
Mailing Address - Country:US
Mailing Address - Phone:850-456-5479
Mailing Address - Fax:850-457-4026
Practice Address - Street 1:4929 MOBILE HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-3229
Practice Address - Country:US
Practice Address - Phone:850-456-5479
Practice Address - Fax:850-457-4026
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist