Provider Demographics
NPI:1568172500
Name:KOLB, KRISTIN (PTA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KOLB
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 1:13631 PARKCREST BLVD APT 138
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4372
Mailing Address - Country:US
Mailing Address - Phone:392-565-0266
Mailing Address - Fax:
Practice Address - Street 1:12780 KENWOOD LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-5605
Practice Address - Country:US
Practice Address - Phone:239-206-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant