Provider Demographics
NPI:1649750209
Name:KOLIBA, BRYAN R (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:R
Last Name:KOLIBA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-2133
Mailing Address - Country:US
Mailing Address - Phone:361-275-9133
Mailing Address - Fax:361-275-8082
Practice Address - Street 1:1310 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-2133
Practice Address - Country:US
Practice Address - Phone:361-275-9133
Practice Address - Fax:361-275-8082
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-09904-2225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist