Provider Demographics
NPI:1467572420
Name:KOLAR, BETTY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:BETTY ANN
Middle Name:
Last Name:KOLAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450-4811
Mailing Address - Country:US
Mailing Address - Phone:352-212-9016
Mailing Address - Fax:352-560-0002
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:SUITE 311
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4811
Practice Address - Country:US
Practice Address - Phone:352-212-9016
Practice Address - Fax:352-560-0002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48062225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist