Provider Demographics
NPI:1780896084
Name:KOLOC, JOSEPH PATRICK (MSPT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PATRICK
Last Name:KOLOC
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4113
Mailing Address - Country:US
Mailing Address - Phone:863-678-0705
Mailing Address - Fax:863-678-0700
Practice Address - Street 1:61 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4113
Practice Address - Country:US
Practice Address - Phone:863-678-0705
Practice Address - Fax:863-678-0700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT206822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic