Provider Demographics
NPI:1467812230
Name:KOLASA, EDYTA HALINA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EDYTA
Middle Name:HALINA
Last Name:KOLASA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 BIG OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:760-318-5648
Mailing Address - Fax:
Practice Address - Street 1:8975 BIG OAK DRIVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:760-318-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03424171W00000X
KYPTA-A03424225200000X
TNPTA0000006184225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No171W00000XOther Service ProvidersContractor