Provider Demographics
NPI:1639927411
Name:KOLB, CALEB (DPT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:KOLB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 REDCORT DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-6096
Mailing Address - Country:US
Mailing Address - Phone:540-577-8031
Mailing Address - Fax:
Practice Address - Street 1:44 CATAWBA RD STE 201
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2694
Practice Address - Country:US
Practice Address - Phone:540-992-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist