Provider Demographics
NPI:1457324691
Name:KOLAGA, EMILY (PT, DPT, CSCS, CKTP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KOLAGA
Suffix:
Gender:F
Credentials:PT, DPT, CSCS, CKTP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WOLKOMIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W307N1499 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2129
Mailing Address - Country:US
Mailing Address - Phone:262-754-1650
Mailing Address - Fax:262-754-0877
Practice Address - Street 1:W307N1499 GOLF RD
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2129
Practice Address - Country:US
Practice Address - Phone:262-754-1650
Practice Address - Fax:262-754-0877
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10229-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI168269Medicare UPIN