MEDICARE: KEVIN KOLLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P18284	NC

General Provider Information

NPI Number	:	1548512015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KOLLY

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 WERRINGTON DR STE 100
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6018
Country	:	US
Telephone Number	:	919-371-5144
Fax Number	:	919-371-5145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	01/13/2025

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Directions to “ KEVIN KOLLY ” Practice Location

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