Provider Demographics
NPI:1477089498
Name:KOLASINSKI, SHELBY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:
Last Name:KOLASINSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16553 COUNTY ROAD 10 3
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:OH
Mailing Address - Zip Code:43533-9627
Mailing Address - Country:US
Mailing Address - Phone:419-261-1032
Mailing Address - Fax:
Practice Address - Street 1:1800 W US HIGHWAY 223
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8439
Practice Address - Country:US
Practice Address - Phone:517-263-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015505225100000X
MI5501018166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist